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This form is for Faculty Career Mentors to complete after meeting with student mentees. Overall this is a general way for mentors to track communications with students.

Name of Faculty Mentor

First

Last

Faculty Specialty

Name of Student Mentee

First

Last

Medical student ‘Year of Training’

Phase 1 Year 2 (MS 1)
Phase 1 Year 2 (MS 2)
Phase 2 (MS 3)
Phase 3 (MS 4)

What are your objectives for today’s meeting:

Is medical student:

Your advisee with School of Medicine. Name advisor if not you.
Requesting letter of recommendation
Seeking information only
Other