BNL/DOE Outstanding Mentor Award online submission form*

*This form should be submitted before the last day of the Summer Undergraduate programs

Name of Undergraduate Student

Today's Date                           

Student's email address:          

Your DOE funded program:        CCI FaST PST SULI LSTPD

Your Mentor's first name:         

Your Mentor's last name:         

Your Mentor's Title:                 

Your Mentor's Mailing Address:

Your Mentor's Email Address:    

Department:                            

Division:                                   

Department Chair:                     

Division Head:                           

Please answer the following questions.  Include as much detail as you can.  Provide specific examples of how your mentor assisted you or made a difference. 

1)  What did you learn from your mentor?

2)  Why do you think your mentor deserves the outstanding mentor award?

Please choose the most appropriate response and provide comments for each of the following items:

3) My mentor provided me with background material prior to my arrival at the lab?

Comments:
 

4) My mentor provided me with a well-defined research project that matched my research interests?

Comments:
 

5) My mentor provided me with support for my involvement in enrichment activities outside my research project?

Comments:
 

6) My mentor provided me with support for the development of my research output, abstract, and education module (for PST students)?

Comments:
 

7)  Please provide specific examples of how your mentor helped you, or made a difference.