Mentorship Award - Awardee Final Report Awardee Information Name: Address: Address 2: City: State/Province: ZIP/Postal Code: Country: Phone: Email: Amount Awarded: Inclusive Dates of Projects: Project Focus: Mentor Name: Awardee's Evaluation 1) I heard about the program through: Friend or Colleague WDS Website WDS Luncheon Other Other (please specify): 2) The mentorship experience was useful in acquiring a new skill set: Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree 3) I would recommend the mentorship experience to colleagues: Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree 4) The duration of my mentorship experience was: Too Long Acceptable Too Short 5) What projects are started or planned with your mentor? (Abstracts, papers, presentations, etc.) - minimum of 100 words 6) What plans do you have for continued professional experiences with your mentor? - minimum of 100 words 7) Please provide a brief summary of your Mentorship experience. This summary will be published in the WDS Annual Report. - maximum of 115 words 8) Please upload a current headshot. This will be published in the WDS Annual Report. 9) Please provide a testimonial about the Mentorship experience - optional: maximum of 115 words 10) Do you have any recommendations or suggestions to make the Mentorship Award Program better for next year? If you had a great experience and would like to nominate your mentor for the WDS Mentor of the Year Award, please send an email to wds@womensderm.org with the nominee's name, C/V, and letter(s) of recommendation. All nominations will be accepted from WDS Members, and will be reviewed by the WDS Mentorship Committee.
