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* 1. Mentee Name (first and last)

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* 2. Mentee's email

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* 3. Where do you go to high school?

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* 4. Are you on track to graduate in May? If not, how are you feeling, what obstacles have you faced, and when is your anticipated graduation date?

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* 5. Do you have a plan for after graduation?

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* 6. If yes, what is your current plan?

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* 7. On a scale of 1-10, how confident do you feel about making this plan happen? (1 is not confident, 10 is very confident)

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* 8. If no or unsure, what barriers are you facing in having a plan?

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* 9. What future path are you most interested in pursuing currently? (can choose your top 1 or 2)

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* 10. On a scale of 1-10, how interested are you in receiving support from your mentor and Save Our Youth to help figure out future plans this next year, and why? (1 is not interested and 10 is very interested)

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* 11. Rate the future planning topics from what you would like the most help with to the least help with.

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* 12. What other topics would you like to cover with your mentor over this next year?

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