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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 child is able to make and keep friends easily.

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* When my child disagrees with his/her friends, they are able to work it out.

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* My child is helpful.

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

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

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* My child is hopeful about his/her future.

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

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* My child likes going to school.

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

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* I feel like my child matters to people in our community.

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

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* I have never been concerned about my child’s safety while he/she was with their mentor.

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* I have noticed positive changes in my child since he/she started being mentored.

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* I would recommend mentoring to my friends (having a mentor for their child/children).

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* I am happy with the amount of communication and support I receive from the mentoring program staff.

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

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* In the last four weeks, how many days was your child absent from school?

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* How far would you LIKE your child to go in school?

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

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