Nurse Mentor Evaluation form

Instructions: Have the student mentee complete this evaluation form regarding his/her experience
with the mentor.

Nurse Mentee’s Name / Title:

I was mentored by the following mentor(s):

The program requirements were clear to me: ☐YES ☐NO

If yes, what was helpful in making the requirements clear?

If no, what would be more helpful in making the requirements clear?

The support level from the mentor program liaison was appropriate: ☐YES ☐NO

If no, what would improve the support level provided?

I was well-matched with my mentor(s) (circle one):☐YES ☐ NO

If no, what improvements would you suggest in the matching process?

I learned the following about myself during the program

I was able to meet all of my learning goals with my mentor’s help: ☐YES ☐ NO

If no, what would have helped you to meet all of your learning goals?

I would recommend this mentor to others: ☐YES ☐NO

If yes, why?

If no, why not AND what would improve this mentor’s ability to mentor?

General Comments:
Please add anything you think would be relevant for the Mentoring Program Liaison
to know in order to improve the mentoring program.