Mentor/Telementor Program Evaluation Form
To be completed by mentors

First Name
Last Name
Company or Organization
E-Mail Address
KanCRN Project/Classroom Worked With:
School Contact (Name)

1. Describe the impact you believe you have had on the teacher(s) you have worked with this year.

2. Describe the impact you believe you have had on the student(s) you have communicated with this year.

3. Would you like to work on the same project next year? Please explain.

4. What advice would you offer to a future mentor?

5. What changes would you recommend be made in the KanCRN program before next year?