Skip to content
Home
Contact
About
Alumni
Mentorship
Schedule A: Student Consent Form
Schedule B: Student Feedback Form
Schedule C: Alumni Consent
Schedule D: Alumni Feedback
Benefactors
News
Events
Testimonials
Donate
Foundation Programs
Apply for Grant
IRS Disclosure Documents
Archive
Home
Contact
About
Alumni
Mentorship
Schedule A: Student Consent Form
Schedule B: Student Feedback Form
Schedule C: Alumni Consent
Schedule D: Alumni Feedback
Benefactors
News
Events
Testimonials
Donate
Foundation Programs
Apply for Grant
IRS Disclosure Documents
Archive
UERM AFUSA Alumni Feedback Questionnaire
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Profile
Specialty
*
Location
*
Sessions
*
Short Answers
What worked:
*
Challenges
*
Improvements
*
Barriers Institutional Assist
Institutional Input
Opportunities
*
Barriers
*
Assist connections?
*
Yes
Maybe
No
Feedback
Mentorship
*
Meaningful engagement
Student preparedness
Good interaction
Provided support
Career Guidance
*
Residency guidance
USMLE insights
CV/research help
Student interest
Program Structure
*
Effective sessions
Relevant topics
Appropriate duration
Easy to facilitate
Clinical (if applicable)
Appropriate level
Improved reasoning
No duplication
Collaboration
*
Willing to share elective info
Can support linkages
Partnerships feasible
Familiar with VSLO
Program Evaluation
*
Well-structured
Time reasonable
Sustainable
Will continue
Valuable
Final Evaluation
Rate (1–5: Poor → Excellent)
Overall Satisfaction
*
1
2
3
4
5
Recommend
*
Yes
No
Modify
Submit
Confidential – For Program Improvement
