Staff Scientists and Staff Clinicians (SSSC) Outstanding Mentor Award (Application)

CCT 2024 Staff Scientists and Staff Clinicians Outstanding Mentor Award

Staff Scientists and Staff Clinicians Outstanding Mentor Award

OMB No.: 0925-0766
Expiration Date: 09/30/2026

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Secondary Nominator Form

You have been selected as a secondary nominator for the following Mentor Award nominee:

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[webform_submission:values:nominee_title]
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[webform_submission:values:branch_1]

Please complete your information and respond to the mentor questions in the form below no later than March 31, 2024.

Primary Nominator

General Information

Please provide the following general information with your nomination.

Complete nomination package no later than March 31, 2024.

Nominee Information

First Name:

Last Name:

Degree(s):

Title:

Nominee Organization Details

Division/Office/Center

Branch/Lab/Program

Campus Location

Telephone:

Email:

Verify Email

Length of time in this position:

Your Information

First Name:

Last Name:

Degree(s):

Your Organizational Details

Division/Office/Center

Branch/Lab/Program

Campus Location

Telephone:

Email:

Verify Email

Your Relationship to the Nominee:

How long has the Nominee been your mentor?

Your nomination is confidential. If your nominee is selected as a winner, may we share your identity with them?

Secondary Nominator

First Name:

Last Name:

Relationship to the Nominee:

Degree(s):

Email:

Confirm email

Telephone:

How many years has nominee been your mentor?

Your nomination is confidential. If your nominee is selected as a winner, may we share your identity with them?

Your Organizational Details

Division/Office/Center

Branch/Lab/Program

Campus Location

Review Criteria:

Please answer ALL the following questions.

Please use the full-scale range of 1-10 to rate your nominee's performance with 1 as low and 10 as high.

Communication (verbal and written):

Questions	1	2	3	4	5	6	7	8	9	10
How well does your mentor explain scientific concepts and methods to you?	1	2	3	4	5	6	7	8	9	10
How open is your mentor to answering your questions and encouraging scientific curiosity?	1	2	3	4	5	6	7	8	9	10

Accessibility:

Questions	1	2	3	4	5	6	7	8	9	10
How easily is your mentor available to you?	1	2	3	4	5	6	7	8	9	10
Does your mentor share his/her knowledge with you?	1	2	3	4	5	6	7	8	9	10

Visibility:

Questions	1	2	3	4	5	6	7	8	9	10
Does your mentor provide you an opportunity to present your work at workshops and meetings (internal or external)?	1	2	3	4	5	6	7	8	9	10
Are you encouraged to write and publish your scientific findings?	1	2	3	4	5	6	7	8	9	10

Mentoring environment:

Questions	1	2	3	4	5	6	7	8	9	10
Does your mentor provide a conducive training environment, including intellectual & tangible support for scientific development?	1	2	3	4	5	6	7	8	9	10
How clear is your mentor in his/her expectations of you?	1	2	3	4	5	6	7	8	9	10

Overall rating:

Questions	1	2	3	4	5	6	7	8	9	10
Please rate your mentor’s overall support/helpfulness to prepare for and meet your career objectives & future aspirations/goal	1	2	3	4	5	6	7	8	9	10

Please provide specific examples that demonstrate the nominee’s commitment to mentoring. (maximum 500 words; more weight will be given to these responses)

How has your mentor encouraged you to continue your scientific career? Please describe.

Communication (verbal and written):

Questions	1	2	3	4	5	6	7	8	9	10
How well does your mentor explain scientific concepts and methods to you?	1	2	3	4	5	6	7	8	9	10
How open is your mentor to answering your questions and encouraging scientific curiosity?	1	2	3	4	5	6	7	8	9	10

Accessibility:

Questions	1	2	3	4	5	6	7	8	9	10
How easily is your mentor available to you?	1	2	3	4	5	6	7	8	9	10
Does your mentor share his/her knowledge with you?	1	2	3	4	5	6	7	8	9	10

Visibility:

Questions	1	2	3	4	5	6	7	8	9	10
Does your mentor provide you an opportunity to present your work at workshops and meetings (internal or external)?	1	2	3	4	5	6	7	8	9	10
Are you encouraged to write and publish your scientific findings?	1	2	3	4	5	6	7	8	9	10

Mentoring environment:

Questions	1	2	3	4	5	6	7	8	9	10
Does your mentor provide a conducive training environment, including intellectual & tangible support for scientific development?	1	2	3	4	5	6	7	8	9	10
How clear is your mentor in his/her expectations of you?	1	2	3	4	5	6	7	8	9	10

Overall rating:

Questions	1	2	3	4	5	6	7	8	9	10
Please rate your mentor’s overall support/helpfulness to prepare for and meet your career objectives & future aspirations/goal	1	2	3	4	5	6	7	8	9	10

Please provide specific examples that demonstrate the nominee’s commitment to mentoring. (maximum 500 words; more weight will be given to these responses)

How has your mentor encouraged you to continue your scientific career? Please describe.