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Public Health Expertise Network of Mentors (PHENOM)
Online Evaluation Form for Mentors

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Welcome to the On-line Public Health Expertise Network of Mentors (P.H.E.N.O.M.) Program Evaluation Form for Mentors!

Your input is appreciated!

Just complete this form. Click on Submit when ready to send.

FOR THE ACADEMIC YEAR OF SEPTEMBER, 2011 - AUGUST, 2012

July, 2002 - You can now submit your annual mentor evaluation online!
Before completing, make sure your computer can process this. Submit a sample form with Test Form. If you get a Thank you, then come back and submit this. Thanks!

Directions: This form allows you to rate your experience and offer comments and suggestions for improving the program. I would like to make sure that the program is fulfilling its intended mission. Thanks!

Mentor:

The Mentor Program is an important Service Program

The Mentor Program is beneficial to students, and others, looking for career direction

I responded to student requests during the past 12 months

Responding to student requests enhances my role as a Public Health Mentor

How would you change PHENOM? :

QUESTIONS, COMMENTS, SUGGESTIONS, ETC.:

I _______ continue as a Public Health Mentor.
Certificate of Appreciation

ADDRESS:

TOWN:

STATE:

ZIP:

COUNTRY:

E-mail:

PHONE:[AREACODE](Home):

PHONE:[AREACODE](Work):

Published on the Web: July 22, 2000; February 21, 2001
UPDATED: November 27, 2011 R71
Comments, suggestions, dead link reports: Betty C. Jung, Webmaster

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