Attachment 15 Mentee Mentor Assessment

OMB #0925-0747
EXP. 11/2019

Attachment 15:

Mentee Mentor Assessment
(Revised 7.31.17)

OMB #0925-0747
EXP. 11/2019

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 faculty
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 #0925-0747
EXP. 11/2019

1. Thinking about your primary research mentor, please indicate how skilled you feel this
person is in each mentoring component listed below. Use a scale from 1 to 7 where 1 =
“Not at all skilled” and 7 = “Extremely skilled.” If you cannot comment, indicate N/A (not
applicable) in the last column.
Not at all
Skilled
(1)

(2)

Moderately
Skilled
(3)
(4)
(5)

Extremely
Skilled
(6)
(7)
(n/a)

(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)

(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)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(n/a)

(1)
Considering how personal and professional
differences may impact expectations
(1)
Working with you to set research goals
Helping you develop strategies to meet goals (1)

(2)

(3)

(4)

(5)

(6)

(7)

(n/a)

(2)

(3)

(4)

(5)

(6)

(7)

(n/a)

(2)

(3)

(4)

(5)

(6)

(7)

(n/a)

Accurately estimating your level of scientific
knowledge
Accurately estimating your ability to conduct
research
Employing strategies to enhance your
knowledge and abilities
Motivating you
Building your confidence
Stimulating your creativity
Acknowledging your professional
contributions

(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)

(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)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(n/a)

Active listening
Providing constructive feedback
Establishing a relationship based on trust
Identifying and accommodating different
communication styles
Employing strategies to improve
communication with you
Coordinating effectively with your other
mentors
Working with you to set clear expectations of
the mentoring relationship
Aligning their expectations with yours

OMB #0925-0747
EXP. 11/2019

Not at all
Skilled
(1)

Negotiating a path to professional independence with you
Taking into account the biases and prejudices they bring to your mentor/mentee
relationship
Working effectively with you-whose personal
background may be different from your
mentor (age, race, gender, class, region,
culture, religion, family composition etc.)
Helping you network effectively
Helping you set career goals
Helping you balance work with your
personal life
Understanding their impact as a role model
Helping you acquire resources
(e.g. grants, etc.)

(2)

Moderately
Skilled
(3)
(4)
(5)

Extremely
Skilled
(6)
(7)
(n/a)

(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)

(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)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(n/a)

2. How would you rate the overall quality of the mentoring you are receiving from your
mentor?
Very low
1

2

3

Average
4

5

6

Very High
7

3. Overall, how satisfied are you with your mentoring/coaching/training relationship?
Not at all
1

2

3

Moderately
4

5

6

Completely
7

4. To what extent do you feel that your mentor is meeting your expectations?
Not at all
1

2

3

Moderately
4

5

6

Completely
7

OMB #0925-0747
EXP. 11/2019

5. Please indicate how frequently each of the following occurred in your relationship with
your primary research mentor.
Never

a. My mentor created opportunities for me to bring up issues of
race/ethnicity as they arose.
b. My mentor encouraged me
to think about how the research
related to my own lived experience.
c. My mentor was willing to discuss race and ethnicity, even if
it may have been uncomfortable
for him/her.
d. My mentor raised the topic
of race/ethnicity in our research
mentoring relationship when it
was relevant.
e. My mentor approached the
topic of race/ethnicity with me in
a respectful manner.

Rarely

Sometimes Frequently

All of the
Time

N/A

OMB #0925-0747
EXP. 11/2019

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

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

OMB #0925-0747
EXP. 11/2019

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
1

2

3

4