1. | Age: |
2 | Length of work experience: |
3 | Place of work (hospital department): |
4. | Length of current employment: |
5. | Job title: |
6. | Length of teaching experience: _______________ hours of clinical teaching; _______________Hospital/Department______year of study |
7. | What motivates you to participate in the Mentor Training Program? |
8. | What are your expectations of the Mentor Training Program? |