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]

Question Title

* Mentee ID Number:

Question Title

* My mentee has positive conflict resolution skills.

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* My mentee is helpful.

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* My mentee tends to bounce back quickly after hard times.

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* When something is bothering my mentee, he/she talks to me about it.

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* My mentee is hopeful about his/her future.

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* My mentee believes what he/she does now will not affect their future.

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* My mentee likes going to school.

Question Title

* My mentee cares about how he/she does in school.

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* I have introduced my mentee to people he/she may not have met otherwise.

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* My mentee has another adult, outside of his/her family, and besides me, whom he/she turns to for support.

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* I have noticed positive changes in my mentee since we started meeting.

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* I would recommend mentoring to a friend, family member, or colleague.

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* I feel I have the support and training I need at this time.

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* Which best describes your role in your mentee’s education? (check all that apply)

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* How far do you think YOUR MENTEE THINKS he/she will go in school?

Question Title

* How far do YOU THINK your mentee will go in school?

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