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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* 1. Mentee ID Number:

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* 2. Mentee Age:

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* 3. I am able to make and keep friends easily.

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* 4. If I get into a disagreement with friends, we are able to work it out.

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* 5. If I see someone needs help, I try to help them.

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* 6. I tend to bounce back quickly after hard times.

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* 7. If I have a problem, I know how to get help.

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* 8. I think I’m going to have a good life when I grow up.

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* 9. What I do now will not affect my life as an adult.

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* 10. I like going to school.

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* 11. I care about how I do in school.

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

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* 13. When I’m with my mentor, I feel important.

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* 14. I feel comfortable while I’m with my mentor.

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

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* 16. I would recommend having a mentor to my friends.

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