Mentor End-of-Relationship 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

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.
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