Last Name:
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First Name:
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Email
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Please list your credentials (degree, license, etc.)
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Institution:
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Christiana Care Health System DSU / Delaware State University DTCC / Delaware Technical Community College Nemours University of Delaware Wesley College Medical University of South Carolina Other
Please identify your institution:
Please list the division / department you primarily work in within your institution:
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Current Rank
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Assistant Research Scientist
Research Scientist
Senior Research Scientist
Principal Research Scientist
Other
If other, please describe your current rank:
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Current Rank
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Instructor / Lecturer
Assistant Professor
Associate Professor
Full Professor
Other
If other, please describe your current rank:
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Please list / describe your current Rank or Title:
Please list / describe your current Rank or Title:
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Years at Current Rank
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1 2 3 4 5 6 7 8 9 10
Do you have a current mentoring team in place?
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Yes
No
Do you feel you need additional mentors?
Yes
No
Briefly list the areas of additional mentoring you may need.
How many mentors do you have?
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1 2 3 4
Primary Mentor:
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Second Mentor:
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Area/Domain ______ is providing support to you in (e.g., biostatistics, methodology, grant writing, etc.)
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Third Mentor:
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Area/Domain ______ is providing support to you in (e.g., biostatistics, methodology, grant writing, etc.)
* must provide value
Fourth Mentor:
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Area/Domain ______ is providing support to you in (e.g., biostatistics, methodology, grant writing)
* must provide value
OVERARCHING GOALS
In just a few sentences, what do you wish to achieve in your career in the next five years?
Below, you will be asked to identify specific one year goals in 4 different domains: Clinical, Teaching, Research, and Leadership. For these four domains, you will specify goals that will help you achieve your overarching goal. Your annual goals should be reviewed and updated at least annually.
You will then be asked to provide immediate objectives that you will work on to reach these goals. Be as specific as possible. Be both qualitative and quantitative. Your objective will be reviewed at each meeting with your primary mentor.
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How many clinical goals would you like to establish?
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0 1 2 3
Clinical Goal 1
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What is your Immediate Objective in Reaching Clinical Goal 1 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
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Clinical Goal 2
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What is your Immediate Objective in Reaching Clinical Goal 2 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
* must provide value
Clinical Goal 3
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What is your Immediate Objective in Reaching Clinical Goal 3 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
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How many teaching goals would you like to establish?
* must provide value
0 1 2 3
Teaching Goal 1
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What is your Immediate Objective in Reaching Teaching Goal 1 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
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Teaching Goal 2
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What is your Immediate Objective in Reaching Teaching Goal 2 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
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Teaching Goal 3
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What is your Immediate Objective in Reaching Teaching Goal 3 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
* must provide value
How many annual research goals would you like to establish?
* must provide value
0 1 2 3
Research Goal1
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What is your Immediate Objective in Reaching Research Goal 1 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
* must provide value
Research Goal 2
* must provide value
What is your Immediate Objective in Reaching Research Goal 2 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
* must provide value
Research Goal 3
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What is your Immediate Objective in Reaching Research Goal 3 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
* must provide value
How many leadership goals would you like to establish?
* must provide value
0 1 2 3
Leadership Goal 1
* must provide value
What is your Immediate Objective in Reaching Leadership Goal 1 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
* must provide value
Leadership Goal 2
* must provide value
What is your Immediate Objective in Reaching Leadership Goal 2 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
* must provide value
Leadership Goal 3
* must provide value
What is your Immediate Objective in Reaching Leadership Goal 3 (______ )?
Your objective should be something specific that you plan to accomplish in the near term - preferably before your next meeting with your mentor.
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In reviewing the goals you set for yourself last year IDP: How successful were you in reaching those goals?
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Not at all
Achieved about 25%
Achieved about 50%
Achieved about 75%
Achieved all or nearly all
This is my first IDP
What hindered you in achieving your goals?
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What helped you in achieving your goals?
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What type of grant proposals do you plan to submit within the next two years?
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When do you plan to submit the NIH, VA, or other federal grant?
Today M-D-Y
When do you plan to submit the Career Development proposal?
Today M-D-Y
When do you plan to submit the Foundation grant?
Today M-D-Y
When do you plan to submit the Corporate grant proposal?
Today M-D-Y
Do you fully understand the criteria for faculty promotion at your institution?
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yes no somewhat
Do you have a draft manuscript, grant, or specific aims page that you would like members of the mentoring oversight team to review?
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Yes
No
Please upload a copy of the grant, specific aims page, or manuscript you would like reviewed. If you do not have one ready, email Erin Riegel (erin.riegel@nemours.org) to set up a time to review your documents.
You should review and update your over-arching goal at least annually.
You should review and update your Clinical, Teaching, Research, and Leadership Goals at least quarterly.
You should review and update your specific objectives at least monthly.
Please check the appropriate boxes.
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I acknowledge joint completion of this plan with my mentoring team.
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Yes
No
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