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Mentor Information and Feedback Form

Dear Mentor,

Thanks again for being a mentor for Inver Hills students.   Please take a minute and fill out this end-of-year feedback form.  We would like to listen to what you have to say and improve our internship.  In addition, we are seeking accreditation for our program this year, the information you provide us will be very helpful during that process.

  1. Please provide the following contact information:
    First name
    Last name
    Organization
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
    Work Phone
    Home Phone
    FAX
    E-mail
    Web Page
  2. What is your date of birth (optional, used for accreditation statistics)?
  3. How many years have you been actively working as a paramedic?


  4. What are some of the positive aspects about the Inver Hills Mentor/Internship program?


  5. What kinds of difficulties or problems did you experience last year with our program, students or staff?


  6. Do you have any suggestions about how to improve our internship program?


  7. If requested, would you like to be a mentor this coming year?

    Yes
    No, never again.
    Take a year off.
    Take several years off.

  8. Please give more feedback. Is there anything else that you would like to share with us?


Copyright Inver Hills Community College
Last revised: September 16, 2002