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This is only a SAMPLE of what the real survey will look like. Please do NOT distribute this version of the survey to constituents of your program.

If you are interested in using the Vermont Mentoring Surveys for your program, please email benji@mobiusmentors.org to receive your unique survey links.

[Program Name/Info Here]

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* Mentee ID Number:

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* I am able to make and keep friends easily.

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* When I disagree with friends, we are able to work it out.

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* When I see someone needs help, I try to help him/her.

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* I tend to bounce back quickly after hard times.

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* When something is bothering me, I know who I can turn to for help.

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* I’m hopeful about my future.

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* What I do now will not affect my future.

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* I like going to school.

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* I care about how I do in school.

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* I feel like I matter to people in my community.

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* I have good relationships with teachers and other adults at my school.

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* When I was with my mentor, I felt important.

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* I felt comfortable while I was with my mentor.

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* Having a mentor has made a difference in my life.

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* I would recommend having a mentor to my friends.

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* In the last four weeks, how many days were you absent from school?

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* How far would you LIKE to go in school?

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* How far do you THINK you will go in school?

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