Discussion Three

Department of Allied Health Sciences (DAHS) Faculty Mentoring Committee

Meeting Form

Mentoring Program Coordinator: Dani Burkhart dani_burkhart@med.unc.edu (919) 966-9040

This form is to be filled out after each mentoring session. At a minimum, two of these reports must be submitted each year

Faculty Member: _____________________ Date of Meeting: ______________________

Mentors Present: _____________________ _____________________ _____________________

1. Topics of Discussion:

2. Career plans:

3. Assessment of overall job satisfaction:

4. Other issues/concerns:

5. Mentoring committee assessment of progress toward established goals:

Signatures:

Faculty Member Date

Primary Mentor Date

The Mentee will provide a copy of this report to the Department Chair, Division Director, and the Mentoring Program Coordinator