Mentee Feedback Form

The following questionnaire is to be completed by the mentéé at least every 8 weeks and forwarded to the co-ordinator. This questionnaire may only be completed once the mentor and mentéé have had an in-depth discussion as to the mentéé’s progress, albeit not. The tangent planes referred to in this questionnaire are those dimensions of behaviour that impact significantly on a mentors effectiveness. Each tangent plane is measured on a scale of 1 to 5. Please use the following guideline when awarding a mark: 5 = ALWAYS – without fail / EXCELLENT 4 = MOST OF THE TIME / GOOD 3 = OFTEN / AVERAGE 2 = SELDOM / POOR 1 = NEVER / DISMAL In addition to the rating, critical incidents relating to both positive performance as well as grey areas relating to that specific dimension needs to be jotted down. If the mentéé needs to make any other comments, these may be jotted down in the General Comments column. Mentéés are required to submit a feedback appraisal form to the Katuka Programme Director in April, July and October of each year.

Give example/describe the incident briefly

5 = ALWAYS – without fail / EXCELLENT 4 = MOST OF THE TIME / GOOD 3 = OFTEN / AVERAGE 2 = SELDOM / POOR 1 = NEVER / DISMAL

Give example/describe the incident briefly

5 = ALWAYS – without fail / EXCELLENT 4 = MOST OF THE TIME / GOOD 3 = OFTEN / AVERAGE 2 = SELDOM / POOR 1 = NEVER / DISMAL

Give example/describe the incident briefly

5 = ALWAYS – without fail / EXCELLENT 4 = MOST OF THE TIME / GOOD 3 = OFTEN / AVERAGE 2 = SELDOM / POOR 1 = NEVER / DISMAL

Give example/describe the incident briefly

5 = ALWAYS – without fail / EXCELLENT 4 = MOST OF THE TIME / GOOD 3 = OFTEN / AVERAGE 2 = SELDOM / POOR 1 = NEVER / DISMAL

Give example/describe the incident briefly

5 = ALWAYS – without fail / EXCELLENT 4 = MOST OF THE TIME / GOOD 3 = OFTEN / AVERAGE 2 = SELDOM / POOR 1 = NEVER / DISMAL

Give example/describe the incident briefly

5 = ALWAYS – without fail / EXCELLENT 4 = MOST OF THE TIME / GOOD 3 = OFTEN / AVERAGE 2 = SELDOM / POOR 1 = NEVER / DISMAL

Give example/describe the incident briefly

5 = ALWAYS – without fail / EXCELLENT 4 = MOST OF THE TIME / GOOD 3 = OFTEN / AVERAGE 2 = SELDOM / POOR 1 = NEVER / DISMAL

Give example/describe the incident briefly

5 = ALWAYS – without fail / EXCELLENT 4 = MOST OF THE TIME / GOOD 3 = OFTEN / AVERAGE 2 = SELDOM / POOR 1 = NEVER / DISMAL

Give example/describe the incident briefly

5 = ALWAYS – without fail / EXCELLENT 4 = MOST OF THE TIME / GOOD 3 = OFTEN / AVERAGE 2 = SELDOM / POOR 1 = NEVER / DISMAL

Give example/describe the incident briefly

5 = ALWAYS – without fail / EXCELLENT 4 = MOST OF THE TIME / GOOD 3 = OFTEN / AVERAGE 2 = SELDOM / POOR 1 = NEVER / DISMAL