FOR THE ACADEMIC YEAR OF SEPTEMBER, 2011 - AUGUST, 2012
July, 2002 - You can now submit an evaluation of your experience with the Public Health Expertise Network of Mentors (P.H.E.N.O.M.) Program on-line! Since 1994, I have collected evaluations from the mentors themselves. As a result of their comments and suggestions, the program has changed in its scope and outreach.
Now it is time to hear from those who use this program. Your feedback will be useful for improving this program.
You can complete an evaluation form for each contact you've made to a mentor. Or, if you have any general comments or suggestions, you can submit an evaluation form as well. You can submit anonymously, but if you want me to get back to you, then provide an e-mail. All responses will be kept confidential. Any forms submitted with less than serious intentions will be discarded. 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. Fill in date, and name of mentor (if applicable). Complete other questions by using the dropdown menus. When done, just press the submit button. Thanks.
CONTACT DATE (i.e., MM/DD/YYYY):
NAME OF MENTOR YOU CONTACTED:
HOW DID YOU HEAR ABOUT THE MENTOR PROGRAM? Brochure Internet search SCSU Alumni Association Web site SCSU Department of Public Health Web site SCSU Public Health Alumni Chapter Web site Word of mouth OTHER:
HOW DID YOU CONTACT THE MENTOR? E-mail In person Internet Phone
WHAT WERE YOU LOOKING FOR? Program info Career advice School advice Other OTHER:
HOW WOULD YOU RATE YOUR EXPERIENCE WITH THE MENTOR PROGRAM? 1 (Very satisfying) 2 (Satisfying) 3 (Average) 4 (Unsatisfying) 5 (Very unsatisfying)
QUESTIONS, COMMENTS, SUGGESTIONS, ETC.:
TOWN/STATE/COUNTRY YOU LIVE IN
AGE:
GENDER: Female Male
NAME:
E-mail:
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© Copyright 1999 - 2012 Betty C. Jung All rights reserved.
