This survey is designed for children and adolescents living in King County, Snohomish county, or Pierce county of Washington State who are 19 years of age and younger and who are currently experiencing mental health illness or dysfunction.

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* 1. How old are you?

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* 2. What gender do you identify with?

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* 3. Have you ever been hospitalized for psychiatric reasons or attended a residential, partial hospitalized program (PHP), intensive outpatient program (IOP) or have had an outpatient psychiatrist or outpatient therapist for a mental health condition?

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* 4. Have you participated in any other mentorship programs before? If yes, which ones?

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* 5. If you answered "yes" to question 4, what did you like and what did you NOT like about the programs?

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* 6. What are your top goals for this year? (examples may be: graduate high school, pass my classes, learn to manage my mental health diagnoses, meet new friends, try a new sport or musical instrument, ect.)

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* 7. What are your top mental health treatment goals for this year? (examples may be: stay out of inpatient or residential, reduce/stop self-harming, reduce panic attacks, increase self-esteem, reduce drug use, better management of PTSD symptoms, stop weighing myself or counting calories, ect.)

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* 8. A mental health mentor is an adult who has experienced similar mental illnesses or mental health struggles as you. Their purpose is to teach or give help and advice to a child or adolescent who has less mental health treatment experience than they do.

What would you want from a mental health mentorship? (Rank from most important at the top to least important at the bottom)

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* 9. Are there other things not listed above that you would want your mentor to support you with?

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* 10. How often would you want to meet with your mentor?

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