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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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* My former mentee has positive conflict resolution skills.

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* My former mentee is helpful and compassionate.

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

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* When something was bothering my mentee, he/she talked to me about it.

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* My former mentee is hopeful about his/her future.

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

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* My former mentee likes going to school.

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

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

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* My former 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 former 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 had the support and training I needed.

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

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

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

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