LSAMP URE Mentor-Participant Check-In Form
LSAMP URE Participant Name
*
First Name
Last Name
LSAMP URE Mentor Name
*
First Name
Last Name
Date of Meeting
*
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Month
-
Day
Year
Date
Time of Meeting
*
1
2
3
4
5
6
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9
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12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Type of Meeting
*
In-person on campus
In-person off campus
Email
Phone
Other
Any Updates to Student Contact Information (address, email, phone number etc.)
DATA: What research objectives have you met this week?
*
SELF-ASSESS: How are you feeling in terms of big picture? How well do you think things are going?
*
PLAN: What steps will be completed by our next meeting?
*
Overall satisfaction with meeting
*
1
2
3
4
5
Highly Unsatisfied
Highly Satisfied
1 is Highly Unsatisfied, 5 is Highly Satisfied
Other comments:
LSAMP URE Participant Signature
LSAMP URE Mentor Signature
Submit
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