Faculty Advisor Evaluation Form

Faculty Advisor Evaluation Form - Due September 15th
Dear Chapter President and/or Co-Presidents (or Designee): The LMSA Chapter Advisor(s) plays a critical role in advising LMSA chapter, regional and/or national members on their strategic plan, annual activities and personal and professional development.

Please take a moment to acknowledge the work of your advisor, from August 2021-April 2022, and to help them develop in their role. The survey takes approximately 10 minutes to complete. Your responses will be kept confidential!

If you have any questions please email LMSA National, Executive Director J.P. Sanchez MD, MPH at exec.director@lmsa.net or LMSA FPAC National Center Director, Deion Ellis MD, MMS dlellis@salud.unm.edu
Email *
example@example.com
Name *

First Name Last Name
Phone Number *
Please enter a valid phone number.
School Chapter Name (spell out full name) *
Advisor Name *
Advisor Phone Number (we are trying to build our directory and need advisor's phone numbers)
Please enter a valid phone number.
Advisor email address (we are trying to build our directory and need advisor's email address)
example@example.com
For how long have you known the advisor?
Example: years or months
Between March 1, 2021 and April 31, 2022, to what extent did your faculty advisor advise your chapter with the following activities:

Do not fill if NA - not applicable
Development of an annual strategic plan that aligns with the mission and objectives of LMSA National

0

1

2

3

0 is Worst, 3 is Best
Implementation and/or evaluation of an annual strategic plan that aligns with the mission and objectives of LMSA National

0

1

2

3

0 is Worst, 3 is Best
Helped organize and plan chapter MEETINGS

0

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3

0 is Worst, 3 is Best
Helped organize and plan chapter EVENTS

0

1

2

3

0 is Worst, 3 is Best
Discussion of on-going and/or emerging Latino/Hispanic related health issues

0

1

2

3

0 is Worst, 3 is Best
Engagement in LMSA regional and/or national activities

0

1

2

3

0 is Worst, 3 is Best
Determination of the personal and/or professional interests of members

0

1

2

3

0 is Worst, 3 is Best
Securing funding and/or resources to support chapter-based events

0

1

2

3

0 is Worst, 3 is Best
Securing funding to support participation in LMSA regional or national activities

0

1

2

3

0 is Worst, 3 is Best
Use this space to further describe how your faculty advisor advised your chapter’s efforts in relation to the statements listed above. Also consider commenting on how your advisor has been able to elevate the perception of LMSA within your medical school community.
Any recommendations on how your faculty advisor can advise your chapter and its members:
How has your advisor been involved on the Regional level

To be completed by regional co-directors or Physician/Faculty Advisory Board members -- Do not fill if NA - not applicable
Presented at regional conference

0

1

2

3

0 is Worst, 3 is Best
Supported a career fair table

0

1

2

3

0 is Worst, 3 is Best
Co-authored a research poster

0

1

2

3

0 is Worst, 3 is Best
Served as a judge in a poster competition, travel scholarships, etc.

0

1

2

3

0 is Worst, 3 is Best
Please describe how your advisor supported regional efforts:
Include title of presentations and types of competitions they have served as judge
How has your advisor been involved on the National level

To be completed by Executive Director or designee -- Do not fill if NA - not applicable
Attended Advisor Training at LMSA National Conference

0

1

2

3

0 is Worst, 3 is Best
Attended Faculty Advisor Trainings

0

1

2

3

0 is Worst, 3 is Best
Served on Faculty/Physician Advisory Board

0

1

2

3

0 is Worst, 3 is Best
Sat on committee

0

1

2

3

0 is Worst, 3 is Best
Nominated for Mentor of the Year

0

1

2

3

0 is Worst, 3 is Best
Served as a judge in a poster competition, travel scholarships, etc.

0

1

2

3

0 is Worst, 3 is Best
Please describe how your advisor supported national efforts:
Include title of presentations, types of competitions they have served as judge, and trainings they have taken part in.
Thank You

Once completed, press submit button below.
Should be Empty:

Faculty Advisor Evaluation Form - Due September 15th

Between March 1, 2021 and April 31, 2022, to what extent did your faculty advisor advise your chapter with the following activities:

How has your advisor been involved on the Regional level

How has your advisor been involved on the National level

Thank You