Mentor Form

Thank you for being willing to be a Site or Academic Mentor for a Fellow for the 2024-25 year. Here is an introduction document to the Fellowship for mentors! The deadline for this survey is February 2nd, 2025. We will be interviewing in March and decisions go out in mid-April. You should hear from the applicant you have been working with at that time if they were selected.

We are asking all possible Mentors to fill out this brief 2-3 minute survey about their experience with the applicant(s). Only one form needs to be filled out for students who are applying together. The applicant should have already shared the Mentor Onboarding Document with you that tells all potential Site and Academic Mentors everything you all need to know about the program. If they have not, it is also available to download here.

Responses will remain confidential and will not be shared with students. They will be considered as part of a holistic review process and your responses will not automatically result in a rejection or elimination.

Your name and title at the school/agency

Applicant Name(s) if applying as a group

Your Institution/Agency name (please note that this is the name of the organization with which YOU are affiliated as a mentor for this specific project)

Will you be a site or academic mentor?

Site Mentor

Academic Mentor

Do you think this project is feasible the way the applicant has planned it?

Yes, it is ready to go as planned.

Yes, but it will need slight modifications to be realistic.

Yes, but it will need significant restructuring or refinement.

No, it would need a complete overhaul.

I don’t understand this project well enough to know.

For Site Mentors only, Academic Mentors may skip to the next question. Please select which answer best fits their project proposal.

This project fulfils a need we have and we have co-created this project.

This project fulfils a need we have but the applicant did not involve me in the creation of the project to any significant degree.

The project doesn’t fulfil a need we have but we agreed to host it because we think it is still of value.

I don’t understand this project well enough to know.

For Site Mentors only, Academic Mentors may skip to the next question. Please list any concerns you have with this project and/or the student(s) (such as bandwidth, student interacting with the community, community trust, project feasibility)

For Academic Mentors only, Site Mentors may skip to the next question. Based on your knowledge of this student(s), how well do you think they align with the goals and values of this Fellowship? Considering our focus on initiative in addressing health inequities, developing leadership skills, and a commitment to making a broader impact beyond their individual project, how prepared and motivated do you feel they are to take on this opportunity and fully engage with our mission?

Is there anything else you would like us to know about the project or the applicant?

Based on the Mentor Responsibilities listed in the document above, I am ready to be the applicant's Site or Academic Mentor.

Yes

I accept terms & conditions

Thank you for submitting!

MENTor form

For Site Mentors only, Academic Mentors may skip to the next question. Please list any concerns you have with this project and/or the student(s) (such as bandwidth, student interacting with the community, community trust, project feasibility)

Is there anything else you would like us to know about the project or the applicant?

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