Faculty Advisor Evaluation Form
Dear Chapter President and/or Co-Presidents (or Designee):  The LMSA Chapter Advisor(s) plays a critical role in advising LMSA chapter, regional and/or national members on their strategic plan, annual activities and personal and professional development.  Please take a moment to acknowledge the work of your advisor, from August 2021-April 2022, and to help them develop in their role.  The survey takes approximately 10 minutes to complete.  Your responses will be kept confidential! If you have any questions please email LMSA FPAC Center Director Deion Ellis or LMSA National, Executive Director J.P. Sanchez MD, MPH  Due May 20, 2022
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Email *
Name of person completing survey? *
Phone number of person completing survey? *
School Chapter Name (spell out full name) *
Advisor Name *
Advisor telephone number (we are trying to build our directory and need advisor's telephone number)
Advisor email address (we are trying to build our directory and need advisor's email address)
Clear selection
For how long have you known the advisor?
Example: years or months
Between March 1, 2019 and April 31, 2020, to what extent did your faculty advisor advise your chapter with the following activities:  
Do not fill if NA - not applicable
Development of an annual strategic plan that aligns with the mission and objectives of LMSA National
Not at all
A great deal
Clear selection
Implementation and/or evaluation of an annual strategic plan that aligns with the mission and objectives of LMSA National  
Not at all
A great deal
Clear selection
Helped organize and plan chapter MEETINGS
Not at all
A great deal
Clear selection
Helped organize and plan chapter EVENTS
Not at all
A great deal
Clear selection
Discussion of on-going and/or emerging Latino/Hispanic related health issues
Not at all
A great deal
Clear selection
Engagement in LMSA regional and/or national activities
Not at all
A great deal
Clear selection
Determination of the personal and/or professional interests of members
Not at all
A great deal
Clear selection
Securing funding and/or resources to support chapter-based events
Not at all
A great deal
Clear selection
Securing funding to support participation in LMSA regional or national activities
Not at all
A great deal
Clear selection
Use this space to further describe how your faculty advisor advised your chapter’s efforts in relation to the statements listed above. Also consider commenting on how your advisor has been able to elevate the perception of LMSA within your medical school community.
Any recommendations on how your faculty advisor can advise your chapter and its members:
How has your advisor been involved on the Regional level
To be completed by regional co-directors or Physician/Faculty Advisory Board members -- Do not fill if NA - not applicable
Presented at regional conference
Not at all
A great deal
Clear selection
Supported a career fair table
Not at all
A great deal
Clear selection
Co-authored a research poster
Not at all
A great deal
Clear selection
Served as a judge in a poster competition, travel scholarships, etc.
Not at all
A great deal
Clear selection
Please describe how your advisor supported regional efforts:
Include title of presentations and types of competitions they have served as judge
How has your advisor been involved on the National level
To be completed by Executive Director or designee -- Do not fill if NA - not applicable
Attended Advisor Training at LMSA National Conference
Not at all
A great deal
Clear selection
Attended Faculty Advisor Trainings
Not at all
A great deal
Clear selection
Served on Faculty/Physician Advisory Board
Not at all
A great deal
Clear selection
Sat on committee
Not at all
A great deal
Clear selection
Nominated for Mentor of the Year
Not at all
A great deal
Clear selection
Served as a judge in a poster competition, travel scholarships, etc.
Not at all
A great deal
Clear selection
Please describe how your advisor supported national efforts:
Include title of presentations, types of competitions they have served as judge, and trainings they have taken part in.
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