DBSA Boston Mentor Form
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Trainee (Full Name) *
Mentor (Full Name) *
Group *
Date *
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DD
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Observations: 1-Excellent | 2-Good | 3-Needs Improvement

Kept to the spirit of the guidelines
 *
Kept to the spirit of the guidelines
List Strengths and Areas for Improvement
Provided everyone a chance to talk
 *
Provided everyone a chance to talk
List Strengths and Areas for Improvement
Facilitated Flow of Discussion
 *
Facilitated Flow of Discussion
List Strengths and Areas for Improvement
Managed monopolizers
 *
Managed monopolizers
List Strengths and Areas for Improvement
Kept discussion on topic
 *
Kept discussion on topic
List Strengths and Areas for Improvement
Redirected discussion when needed
 *
Redirected discussion when needed
List Strengths and Areas for Improvement

Treated all members with respect

 *
Treated all members with respect
List Strengths and Areas for Improvement

Attended to member and group crises

 *
Attended to member and group crises
List Strengths and Areas for Improvement

Chose and used support of buddy effectively

 *
Chose and used support of buddy effectively
List Strengths and Areas for Improvement

Was able to hear and understand comments made by mentor, showing insight and willingness to make changes and adjustment in their facilitation practice

 *
Was able to hear and understand comments made by mentor, showing insight and willingness to make changes and adjustment in their facilitation practice
List Strengths and Areas for Improvement

List up to 3 areas of improvement that the Trainee will work on

 *

Trainee Self-Assessment - Challenges

Trainee Self-Assessment - Successes

Trainee Self-Assessment - Improvements

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