Mentor Beginning/Mid-Year Self-Evaluation Form ©
Please provide some basic information about yourself, the mentoring program in which you're participating, and the current timing of your mentoring relationship (if applicable).

IMPORTANT NOTE: Before submitting this form, please PRINT this page or SAVE your self-evaluation results by copying/pasting into a Word Document.

Full Name *
Your answer
Class Year or Job Title/Department *
Example: Sophomore, Senior (for students), Program Coordinator/ZSR Library (for faculty/staff)
Your answer
Please indicate the type of mentoring relationship in which you are currently involved: *
If participating in a Formal Mentoring Program, please list the name of the program:
Example: First Year in Focus, Magnolia Scholars, CHARGE
Your answer
Please rate yourself on the following statements below to assess your progress towards developing key mentor competencies. This self-evaluation provides an opportunity to reflect on your growth from the beginning to the end of a mentoring relationship.

Rating scale: 1 - Never, 2 - Rarely, 3 - Sometimes, 4 - Often, 5 - Always

If you are at the beginning of your mentoring relationship and have not had the opportunity to act on or had past experience with the following statements, please indicate that below.

I create a safe space for others to work on learning goals by maintaining confidentiality. *
I willingly share personal stories and experiences with others. *
I provide concrete, objective feedback to support my mentee's learning goals. *
I connect my mentee to people and resources to support his/her progress towards goals. *
I actively create learning moments to support my mentee's progress towards goals. *
I ask questions to encourage my mentee to reflect on experiences and lessons learned. *
I create specific learning goals and action steps that I will work on during the mentoring relationship. *
I set aside time to reflect on lessons learned from experience. *
I consider my mentoring relationship to be a supportive one.
I am able to give and receive feedback within my mentoring relationship.
I feel as though my mentee is interested in me and this mentoring relationship.
Provide any additional comments below.
Your answer
IMPORTANT NOTE: Before submitting this form, please PRINT this page or SAVE your self-evaluation results by copying/pasting into a Word Document.
Submit
Never submit passwords through Google Forms.
This form was created inside of Wake Forest University. Report Abuse - Terms of Service - Additional Terms