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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@mentorvt.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. If I see my mentee get into a disagreement with their friends, they are able to work it out.

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* 4. My mentee is helpful.

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* 5. If something upsetting happens to my mentee, they are able to get over it quickly.

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* 6. If something is bothering my mentee, they talk to me about it.

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* 7. My mentee is hopeful about their future.

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* 8. My mentee believes what they do now will not affect their life as an adult.

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* 9. My mentee likes going to school.

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* 10. My mentee cares about how they do in school.

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* 11. I have introduced my mentee to people they may not have met otherwise.

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* 12. My mentee feels like they matter to people in their community.

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

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

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

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

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