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This is only a SAMPLE of what the real survey will look like. Please do NOT distribute this version of the survey to constituents of your program.

If you are interested in using the Vermont Mentoring Surveys for your program, please email benji@mentorvt.org to receive your unique survey links.

[Program Name/Info Here]

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* 1. Mentee ID Number:

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* 2. Mentee Age:

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* 3. My child is able to make and keep friends easily.

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* 4. If my child has a disagreement with their friends, they are able to work it out.

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* 5. My child is helpful.

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* 6. If something upsetting happens to my child, they are able to get over it quickly.

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* 7. If something is bothering my child, they talk to me about it.

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* 8. My child is hopeful about their future.

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* 9. My child believes what they do now will not affect their life as an adult.

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* 10. My child likes going to school.

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* 11. My child cares about how they do in school.

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* 12. My child feels like they matter to people in their community.

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* 13. I have never been concerned about my child’s safety while they were with their mentor.

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* 14. I have noticed positive changes in my child since they started being mentored.

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* 15. I would recommend mentoring to my friends (having a mentor for their child/children).

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* 16. I am happy with the amount of communication and support I receive from the mentoring program staff.

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* 17. What best describes your role in your child’s education? (check all that apply)

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