Connecting Generations 2015 Parent Survey Question Title * 1. School name Question Title * 2. Date Question Title * 3. Teacher name Question Title * 4. Child's name Question Title * 5. Child's grade Question Title * 6. Child's gender Male Female Question Title * 7. Mentor's name Question Title * 8. Mentor's gender Male Female Question Title * 9. How many years has your child been in the mentoring program? Question Title * 10. If more than one year, did you child have the same mentor as previous years? Yes No Question Title * 11. Do you hope your child can continue with the same mentor next year? Yes No Question Title * 12. Do you want your child to participate in our program next year? Yes No Question Title * 13. Yes reasons for question 12 (please check all that apply): Mentoring helps my child's self-esteem My child is "opening up" as a result of mentoring My child has taken a more positive interest in school since being mentored My child looks forward to his/her mentoring sessions My child benefits from having a same-gender role model Other (please specify) Question Title * 14. No reasons for question 12 (please check all the apply): My child didn't seem very interested in being mentored I feel the time out of class has hurt my child academically My child was disappointed because he/she could not depend on the mentor My child is moving out of the area I don't think that mentoring helped my child Other (please specify) Question Title * 15. Overall, mentoring has helped my child: A lot Some Very little Not at all Question Title * 16. Please rate the changes in your child's relationships this past year based on the effects of the mentoring relationship. (please check only one box per row) Much better Better No change Worse Much worse Don't know Shows trust towards you Shows trust towards you Much better Shows trust towards you Better Shows trust towards you No change Shows trust towards you Worse Shows trust towards you Much worse Shows trust towards you Don't know Shows respect for adults Shows respect for adults Much better Shows respect for adults Better Shows respect for adults No change Shows respect for adults Worse Shows respect for adults Much worse Shows respect for adults Don't know Relationship with family Relationship with family Much better Relationship with family Better Relationship with family No change Relationship with family Worse Relationship with family Much worse Relationship with family Don't know Relationship with peers Relationship with peers Much better Relationship with peers Better Relationship with peers No change Relationship with peers Worse Relationship with peers Much worse Relationship with peers Don't know Relationship with other adults Relationship with other adults Much better Relationship with other adults Better Relationship with other adults No change Relationship with other adults Worse Relationship with other adults Much worse Relationship with other adults Don't know Question Title * 17. Please rate the changes in your child's personal growth this past year based on the effects of the mentoring relationship. (please check only one box per row) Much better Better No change Worse Much worse Don't know Self confidence Self confidence Much better Self confidence Better Self confidence No change Self confidence Worse Self confidence Much worse Self confidence Don't know Self control Self control Much better Self control Better Self control No change Self control Worse Self control Much worse Self control Don't know Cooperation Cooperation Much better Cooperation Better Cooperation No change Cooperation Worse Cooperation Much worse Cooperation Don't know Responsibility Responsibility Much better Responsibility Better Responsibility No change Responsibility Worse Responsibility Much worse Responsibility Don't know Able to express feelings Able to express feelings Much better Able to express feelings Better Able to express feelings No change Able to express feelings Worse Able to express feelings Much worse Able to express feelings Don't know Decision making skills Decision making skills Much better Decision making skills Better Decision making skills No change Decision making skills Worse Decision making skills Much worse Decision making skills Don't know Thinks before acting Thinks before acting Much better Thinks before acting Better Thinks before acting No change Thinks before acting Worse Thinks before acting Much worse Thinks before acting Don't know Has interest or hobbies Has interest or hobbies Much better Has interest or hobbies Better Has interest or hobbies No change Has interest or hobbies Worse Has interest or hobbies Much worse Has interest or hobbies Don't know Question Title * 18. Please rate the changes in your child's school performance this past year based on the effects of the mentoring relationship. (please check only one box per row) Much better Better No change Worse Much worse Don't know Attendance Attendance Much better Attendance Better Attendance No change Attendance Worse Attendance Much worse Attendance Don't know Completes homework Completes homework Much better Completes homework Better Completes homework No change Completes homework Worse Completes homework Much worse Completes homework Don't know Pays attention Pays attention Much better Pays attention Better Pays attention No change Pays attention Worse Pays attention Much worse Pays attention Don't know Follows directions Follows directions Much better Follows directions Better Follows directions No change Follows directions Worse Follows directions Much worse Follows directions Don't know Attitude towards learning Attitude towards learning Much better Attitude towards learning Better Attitude towards learning No change Attitude towards learning Worse Attitude towards learning Much worse Attitude towards learning Don't know Participates in class Participates in class Much better Participates in class Better Participates in class No change Participates in class Worse Participates in class Much worse Participates in class Don't know Question Title * 19. Do you feel your child's mentor has positively affected your child's academic performance? Yes No Unsure Question Title * 20. Additional Comments: Thank you for completing our survey! Done
