MENTOR Survey

Please provide the names of the mentor and the one child you mentor. *This question is required.

Mentor Name
Mentee Name

What is the age of the mentor? This question requires a valid number format.

years old

What is the age of the child you mentor? This question requires a valid number format.

years old

1. How many times per month do you normally see the child you mentor? *This question is required.

2. How many hours do you spend with the child you mentor when you get together? This question requires a valid number format.

hours

3. How many total months have you been a mentor to this child? (For example: 1 and half years would equal 18 months) This question requires a valid number format.

months

5. What is your race/ethnicity?

6. How many adults who (1) love the child you mentor and (2) are not in the child's family interact with the child each week? Please estimate or skip if you have no idea. This question requires a valid number format.

adults

7. How many days per week is the child at home without any adults for more than 1 hour? Please estimate or skip if you have no idea. This question requires a valid number format.

days

8. How many miles do you live from the child you mentor? This question requires a valid number format.

miles

9. How many bad behavior referrals did your child have last semester at school? Please estimate or skip if you have no idea. This question requires a valid number format.

incidents

10. How many bad behavior referrals did the child you mentor have the semester before getting a mentor? Please estimate or skip if you have no idea. This question requires a valid number format.

incidents

MENTOR Survey

Part 1 INSTRUCTIONS