1. What is going well in the mentor-mentee relationship? What is working? What are the benefits?
2. What challenges have you confronted in the mentor-mentee relationship? What barriers exist? What is not working well?
3. What recommendations do you have for strengthening or improving the mentor-mentee program? Any mid-course corrections we should make?
4. General feedback: any other ideas, comments or suggestions?
Name of Mentor:__________________________
Name of Mentee: ____________________________
Please complete and return this quarterly feedback form at the end of September, December, March and June to: Chair, Board of Trustees Governance Committee Sierra Vista Regional Health Center