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* 1. Mentor Name

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* 2. Site:

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* 3. Number of referrals made for additional services for your mentees:

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* 4. Do you have a good relationship with your mentees?

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* 5. What type of contact? Check all types of contacts used

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* 6. Check the activities that apply to your mentoring sessions.

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* 7. TEAM mentoring is making a difference.

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* 8. The monthly calendar is helpful in setting goals with my mentees.

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* 9. The Plan of Study reviewing is making a difference with my mentees.

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* 10. Additional training for mentors would be helpful.

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* 11. Do you think mentoring improves student attendance?

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* 12. Do you think mentoring prevents dropouts?

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* 13. Do you think mentoring improves the graduation rate?

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* 14. Is the mentoring program worth the cost of the program?

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* 15. Do you wish to continue to be a mentor.

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* 16. Mentoring frustrations.

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* 17. Suggestions for improving the mentoring program.

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