Final Evaluation of the Student by the Senior Mentor
Final Evaluation of the Student by the Senior Mentor
Fall (Please enter the current year.)
*
Name of Student Evaluated
Name of Student Evaluated
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First
Last
5 is Strongly Agree
1 is Strongly Disagree
The student arrived on time for the visits.
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The student arrived on time for the visits.
5
4
3
2
1
5 is Strongly Agree
1 is Strongly Disagree
The student conducted himself/herself in a professional manner throughout the visits.
*
The student conducted himself/herself in a professional manner throughout the visits.
5
4
3
2
1
5 is Strongly Agree
1 is Strongly Disagree
The student was prepared for the visits.
*
The student was prepared for the visits.
5
4
3
2
1
5 is Strongly Agree
1 is Strongly Disagree
The student participated actively in the interviews.
*
The student participated actively in the interviews.
5
4
3
2
1
5 is Strongly Agree
1 is Strongly Disagree
The student was comfortable asking questions.
*
The student was comfortable asking questions.
5
4
3
2
1
5 is Strongly Agree
1 is Strongly Disagree
The student exhibited good listening skills.
*
The student exhibited good listening skills.
5
4
3
2
1
5 is Strongly Agree
1 is Strongly Disagree
The student was interested in what I think.
*
The student was interested in what I think.
5
4
3
2
1
5 is Strongly Agree
1 is Strongly Disagree
I’m happy with the relationship I’ve developed over the past 12 months with this student.
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I’m happy with the relationship I’ve developed over the past 12 months with this student.
5
4
3
2
1
5 is Strongly Agree
1 is Strongly Disagree
The student will be a competent physician.
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The student will be a competent physician.
5
4
3
2
1
5 is Strongly Agree
1 is Strongly Disagree
The student will be a compassionate physician.
*
The student will be a compassionate physician.
5
4
3
2
1
5 is Strongly Agree
1 is Strongly Disagree
Think back on your interactions with your student over the past 12 months. Has your student changed or grown? If yes, how?
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Additional Comments about the student:
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Senior Mentor Name
Senior Mentor Name
*
First
Last
Date
Date
*
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