Form 14 Mentee Mentor Assessment

OMB #0925-XXXX
EXP. XX/XXXX

Attachment 15:

Mentee Mentor Assessment

OMB #0925-XXXX
EXP. XX/XXXX

is involved in a large effort funded by the National Institutes of Health (NIH) to
support students and faculty in science, technology, engineering, and mathematics (STEM) fields.
This effort, the NIH Diversity Consortium, is seeking to understand what programs and strategies
can benefit students interested in STEM careers.

The University of California, Los Angeles (UCLA) will be collecting information about these
programs. For some analyses, it will be important to compare students and faculty in STEM majors
at to those at other institutions as well as students and fauclty interested in
other fields.

Your mentor provided your name as part of a survey about mentoring. Your mentor will not
have access to any of the information your provide. All of the information you provide will be
protected and secured to the extent permitted by law. We ask for your name and address so
that the researchers at UCLA can contact you at some later date for follow-up study.
Public reporting burden for this collection of information is estimated to average 10 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless it displays a currently valid OMB control number. Send comments
regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive,
MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*). Do not return the completed form
to this address.

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OMB #0925-XXXX
EXP. XX/XXXX

Student Survey: Assessments of Mentor
1. How would you rate the overall quality of the mentoring you received?
Very low
a. How would you rate
the overall quality of the
mentoring you received

2

1

4

3

Not at all
b.To what extent do you feel
this mentor is meeting your
expectations

Very high

Average
5

6

7

Moderately

1

2

3

Completely
5

4

6

7

2. Please rate how skilled you feel your primary mentor is in each of the following areas:
[We understand that you can only speak from your personal experience. Please try to rate a
skill whenever possible, reserving the 'not observed' category for cases where you have no
basis for assessment].

Mentoring Competency Assessment
Not at all

Extremely

Not
observed

a. Active listening

1

2

3

4

5

6

7

N/A

b. Providing constructive
feedback

1

2

3

4

5

6

7

N/A

c. Establishing a relationship
based on trust

1

2

3

4

5

6

7

N/A

d. Identifying and
accommodating different
communication styles

1

2

3

4

5

6

7

N/A

e. Working with mentees to
set clear expectations of the
mentoring relationship

1

2

3

4

5

6

7

N/A

f. Aligning your
expectations with your
mentees'

1

2

3

4

5

6

7

N/A

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g. Considering how personal
and professional differences
may impact expectations

1

2

3

4

5

6

7

N/A

h. Working with mentees to
set research goals

1

2

3

4

5

6

7

N/A

i. Helping mentees develop
strategies to meet goals

1

2

3

4

5

6

7

N/A

j. Accurately estimating
your mentees' level of
scientific knowledge

1

2

3

4

5

6

7

N/A

k. Accurately estimating
your mentees' ability to
conduct research

1

2

3

4

5

6

7

N/A

l. Employing strategies to
enhance your mentees'
knowledge and abilities

1

2

3

4

5

6

7

N/A

m. Motivating your mentees

1

2

3

4

5

6

7

N/A

n. Building mentees'
confidence

1

2

3

4

5

6

7

N/A

o. Stimulating
mentees' creativity

1

2

3

4

5

6

7

N/A

p. Acknowledging mentees'
professional contributions

1

2

3

4

5

6

7

N/A

q. Negotiating a path to
professional independence
with mentees

1

2

3

4

5

6

7

N/A

1

2

3

4

5

6

7

N/A

1

2

3

4

5

6

7

N/A

t. Helping mentees network
effectively

1

2

3

4

5

6

7

N/A

u. Helping mentees
set career goals

1

2

3

4

5

6

7

N/A

r. Taking into account the
biases and prejudices they
bring to the
mentor/ mentee relationship
s. Working effectively with
mentees whose personal
background is different from
their own (age, race,
gender, class, region,
culture, religion, family
composition etc.)

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v. Helping mentees balance
work with their personal life

1

2

3

4

5

6

7

N/A

w. Helping mentees acquire
resources (e.g. grants, etc.)

1

2

3

4

5

6

7

N/A

3. Please respond to the following statements regarding your primary mentor:

Mentor Actions
Skill

a. My mentor gave me an
overview of how my research
fit into an overall research
project.
b. My mentor helped me
develop my research skills.
c. My mentor showed interest
in my research project.
d. My mentor was available to
me when I had problems or
questions about my research.
e. My mentor offered
constructive feedback when
necessary.
f. My mentor and I developed
a relationship based on trust.
g. My mentor understood how
I learn best.
h. My mentor created an
environment that allowed
me to achieve my goals.
i. My mentor seemed so busy
that I was afraid to interrupt
her/him.
j. My mentor had an effective
mentoring style.
k. My mentor had an effective
mentoring style.

My mentor did
not do this

My mentor tried
to do this but
was ineffective

My mentor did
this sometimes,
and was effective

My mentor did
this frequently,
and was effective

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

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l. My mentor acted as a
positive role model.
m. My mentor showed
interest in me as a person.
n. My mentor fostered
my independence.
o. My mentor fostered
confidence in my skills.
p. My mentor appreciated
my contributions.
q. My mentor encouraged
me to be creative.
r. My mentor made me
enthusiastic about my
project.
s. My mentor helped me feel
curious about my project.
t. My mentor treated me as
a colleague.
u. My mentor helped me
decide on a career path.
v. My mentor communicated
his/her expectations of me.
w. My mentor respected
my goals.
x. My mentor allowed me to
take ownership in my
research.
y. My mentor created an
environment where I felt
safe to make mistakes.
z.My mentor made me feel
included in the lab.
aa. My mentor regularly
assessed skills and
knowledge that I gained in
the lab

3

4

3

4

3

4

2

3

4

2

3

4

2

3

4

2

3

4

2

3

4

2

3

4

2

3

4

2

3

4

2

3

4

2

3

4

2

3

4

2

3

4

1

2

1

2

1

2

1
1
1
1
1
1
1
1
1
1
1
1

2

1

4

3

4. In your mentoring relationship, how important is it to you that your primary research mentor

Is willing to discuss diversity
Considers their own cultural
background, as well as yours
Values and respects cultural
differences

Not at all important

Somewhat
important

Very important

1

2

3

1

2

3

1

2

3

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In your mentoring relationship,
how skilled is your primary
research mentor…
Discussing diversity
Considering their own cultural
background, as well as yours
Valuing and respecting cultural
differences

Not at all

Somewhat

Very

1

2

3

1

2

3

1

2

3

How satisfied are you with the mentoring you are receiving from your primary mentor?

Very Low
1

Back

Average
2

Next

3

Cancel

4

Very High
5

6

7