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Peer Mentor Program Survey

Peer Mentoring Program

Peer mentoring programs are designed to bring people in similar stages of life together for group sessions and/or one-to-one support. A mentor offers guidance based on lived experience. They help a mentee work through challenges and celebrate successes. We invite you to take this survey to let us know about your interest in this programming. Cuyahoga DD would like to help you find an existing program or work with our community partners to create new peer mentoring opportunities.
Section 1: Mentoring Program Interest
1.Are you interested in participating in a peer mentoring program?(Required.)
2.If yes, what role are you interested in?
3.If no, please tell us why this type of program does not interest you.
Section 2: Mentoring Program Preferences
4.How important are the following features in a peer mentoring program?(Required.)
Very important
Important
Neutral
Not important
Mentor training
Flexible scheduling
Confidential conversations
Group mentoring sessions
One-to-one mentoring sessions
5.How often would you like to meet?(Required.)
6.What meeting format would you prefer?(Required.)
7.What is a comfortable size for group mentoring sessions?(Required.)
8.What topic(s) are you interested in? (Select all that apply)(Required.)
9.What are your main reasons for wanting to participate? (Select all that apply)(Required.)
Section 3: Personal Information
10.What categories best describe your impairment, condition, or access need? (Select all that apply)
11.What is your age group?
12.What is your primary language?
13.Where do you live?
14.What type of transportation do you use? (Select all that apply)
15.Do you require any support with communication, access or adaptive equipment during mentoring meetings? (Select all that apply)
If you want more information about peer mentoring programs, please provide your contact information.
16.Name
17.Phone Number
18.Email Address