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Mentoring Survey (effective 7/2011)
Welcome!
Please answer all questions to be eligible for our drawing for the iPad or one of ten gift cards. Thank your for helping our research help others.
1.
Contact info is optional for the survey, but all fields are required for entry in our iPad, gift card drawing to ensure that we can reach you. EduGuide is an independent nonprofit research group that does not share contact information with third parties.
Name:
Company:
Address:
Address 2:
City/Town:
State:
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Email Address:
Phone Number:
*
2.
What is/are your role(s)? Check all that apply.
(Required.)
Program Director
Grant Writer
Evaluator
Program Staff
Parent
Student
Other
Other (please specify)
*
3.
Would you like us to keep you informed of the outcomes of this survey as well as EduGuide work on mentoring and related topics?
(Required.)
Yes
No
*
4.
What roles have you played in mentoring programs?
(Check all that apply)
(Required.)
Mentor
Mentee
Program Coordinator
None at this time, but have plans to do mentoring in the future
None
*
5.
Which networks does your program currently participate in?
(Required.)
College Access Challenge Grant
GEAR UP-National Council for Community and Education Partnerships
National Partnership for Educational Access
TRIO-Council for Opportunity in Education
National College Access Network
MENTOR
Other (please specify)
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