Connecting Generations

Mentor's End of Year Survey

Thank you for volunteering as an in-school mentor and for taking the time to complete this survey. It’s very important in helping us to evaluate the impact mentoring has had both on your life and on the life of your mentee this school year. Your input will be valuable in the further development of our mentoring program.

First Name: Last Name:
Street Address:
City: State: Zip:
Home Phone Number: Email Address:
Work Phone Number:
What year did you begin as an in-school mentor?
Did you actively mentor this school year? Yes No
Do you plan to be a mentor next school year? Yes No

Please complete the following information if you would like to be removed from our mailing list.

Please remove me from the mailing list because (check one):
I am not a Creative Mentor
I did not mentor this school year and will not mentor next school year
Other

Part II The following questions are about “being” a mentor.

1. How many children did you mentor this year?

2. Please answer the following if you are employed and take time to mentor during your regular work hours. (Please check all that apply).

My employer encourages employees to mentor.

My employer gives me release time to mentor.

I use my lunchtime or make up missed work time.

I feel better/am more productive when I return to work after mentoring.

Sometimes my workload requires me to miss a mentoring session.

I am concerned that I may not be able to continue mentoring during work hours.

I have a better feeling toward my employer because I am able to mentor

Part III
The following questions are about your overall mentoring experience this year.

1. In general, were you satisfied with your student match(es)? Satisfied
Dissatisfied

1a. If you were not completely satisfied with your student match, what were the primary reasons? (Check all that apply.) Cultural gap (race, economic, gender)
Child did not seem interested
As a mentor you felt unwanted by the child
Lack of good “chemistry”
Other

2. How do you feel about the assistance/support you got from your mentee’s teacher? Satisfied
Dissatisfied

3. How do you feel about the way in which the school’s office staff treated you? Satisfied
Dissatisfied

4. In general, how do you feel about the assistance/support you got from your School Mentoring Coordinator or Mentor Administrator? Satisfied
Dissatisfied

5. How would you rate the training you received from your mentoring service provider (Big Brothers Big Sisters, Creative Mentoring, HOSTS, etc.) Very Good
Good
Fair
Poor

6. How would you rate the amount of support and contact you received from your mentoring service provider (Big Brothers Big Sisters, Creative Mentoring, HOSTS, etc.) I received just the right amount of support and contact
I needed more contact & support
I needed less contact and support

7. Overall, did you enjoy your mentoring experience this past year? Yes
No

Comments:

Part IV. The following questions are about your mentee.

If you mentor more than one child, please complete one survey for each child you currently mentor.

Child’s First Name

1. How long have you mentored this child? Months    Years

2. At what school or site do you mentor this child?

3. Child’s Gender (Choose One) M    F

4. Child’s current grade in school

5. How frequently was your mentee absent or unavailable due to school trips, assemblies, etc. on your scheduled day?
Very frequently   Infrequently   Never

6. Do you plan to mentor this same child next year? (Choose One)
Yes   No   Not Sure

Please consider how you feel the mentoring relationship has affected your student over the course of this school year and check the column that best reflects the change you have noted.

Much Better A Little Better No Change A Little Worse Much Worse Do not Know Not a Problem

CARING

Shows Trust Towards You

Shows Respect for Adults

Respects Other Cultures

Relationship with Family

Relationships with Peers

Relationship with Other Adults

Much Better A Little Better No Change A Little Worse Much Worse Do not Know Not a Problem

Personal Growth

Self Confidence

Self Control

Cooperation

Responsibility

Able to Express Feelings

Can Make Decisions

Thinks Before Acting

Classroom Behavior

Has Interests or Hobbies

Personal Hygiene/Appearance

Able to Avoid Delinquency

Able to Avoid Substance Abuse

Sense of the Future

Much Better A Little Better No Change A Little Worse Much Worse Do not Know Not a Problem

Competence

Attendance

Initiative

Pays Attention

Follows Directions

Attitude Towards Learning

Completes Assigned Tasks

Class Participation

Works Independently

Works Well with Others

School Preparedness (homework)

Academic Performance

Additional Comments:

Thank you for completing our survey.

Part II The following questions are about “being” a mentor.
1.	How many children did you mentor this year?
2.	Please answer the following if you are employed and take time to mentor during your regular work hours. (Please check all that apply).
		My employer encourages employees to mentor.
		My employer gives me release time to mentor.
		I use my lunchtime or make up missed work time.
		I feel better/am more productive when I return to work after mentoring.
		Sometimes my workload requires me to miss a mentoring session.
		I am concerned that I may not be able to continue mentoring during work hours.
		I have a better feeling toward my employer because I am able to mentor

1.	In general, were you satisfied with your student match(es)?	Satisfied Dissatisfied
	1a. If you were not completely satisfied with your student match, what were the primary reasons? (Check all that apply.)	Cultural gap (race, economic, gender) Child did not seem interested As a mentor you felt unwanted by the child Lack of good “chemistry” Other
2.	How do you feel about the assistance/support you got from your mentee’s teacher?	Satisfied Dissatisfied
3.	How do you feel about the way in which the school’s office staff treated you?	Satisfied Dissatisfied
4.	In general, how do you feel about the assistance/support you got from your School Mentoring Coordinator or Mentor Administrator?	Satisfied Dissatisfied
5.	How would you rate the training you received from your mentoring service provider (Big Brothers Big Sisters, Creative Mentoring, HOSTS, etc.)	Very Good Good Fair Poor
6.	How would you rate the amount of support and contact you received from your mentoring service provider (Big Brothers Big Sisters, Creative Mentoring, HOSTS, etc.)	I received just the right amount of support and contact I needed *more* contact & support I needed *less* contact and support
7.	Overall, did you enjoy your mentoring experience this past year?	Yes No
Comments:

Part IV. The following questions are about your mentee.

If you mentor more than one child, please complete one survey for each child you currently mentor.

Child’s First Name
1.	How long have you mentored this child? Months Years
2.	At what school or site do you mentor this child?
3.	Child’s Gender (Choose One) M F
4.	Child’s current grade in school
5.	How frequently was your mentee absent or unavailable due to school trips, assemblies, etc. on your scheduled day? Very frequently Infrequently Never
6.	Do you plan to mentor this same child next year? (Choose One) Yes No Not Sure

	Much Better	A Little Better	No Change	A Little Worse	Much Worse	Do not Know	Not a Problem
CARING
Shows Trust Towards You
Shows Respect for Adults
Respects Other Cultures
Relationship with Family
Relationships with Peers
Relationship with Other Adults
	Much Better	A Little Better	No Change	A Little Worse	Much Worse	Do not Know	Not a Problem
Personal Growth
Self Confidence
Self Control
Cooperation
Responsibility
Able to Express Feelings
Can Make Decisions
Thinks Before Acting
Classroom Behavior
Has Interests or Hobbies
Personal Hygiene/Appearance
Able to Avoid Delinquency
Able to Avoid Substance Abuse
Sense of the Future
	Much Better	A Little Better	No Change	A Little Worse	Much Worse	Do not Know	Not a Problem
Competence
Attendance
Initiative
Pays Attention
Follows Directions
Attitude Towards Learning
Completes Assigned Tasks
Class Participation
Works Independently
Works Well with Others
School Preparedness (homework)
Academic Performance