Connecting Generations

Parent’s End of Year Survey
Thank you for participating in the mentoring program and for taking the time to complete this survey. It’s very important in helping us to assess the impact mentoring has had on your child this school year. Please fill out and submit this form as soon as possible.
School   Date:  7/4/2009
Teacher’s Name   Child's Grade  
Child's Name   Child’s Gender  M   F
Mentor’s Name   Mentor’s Gender  M   F
Please indicate if this was this child’s first year in the mentoring program.
Yes   No
If No, did this child have the same mentor this year as in previous years?
Yes   No
1.   What were your impressions of your child’s feelings about the mentoring experience? Please check all that apply.
  My child and his/her mentor became special friends.
  My child looked forward to his/her mentoring sessions.
  Mentoring had a very positive effect on my child.
  Being mentored helped my child feel good about him/herself.
  My child didn’t seem very interested in being mentored.
  My child wanted a mentor, but didn’t seem to like the mentor he/she was assigned.
  My child was disappointed in his/her mentor because he/she couldn’t count on the mentor being there every week.
2. Would you recommend that your child be part of next year’s program?
  Yes   No   Uncertain
Please check all that apply:
"Yes" reasons...
I hope my child can continue with the same mentor next year.
I would like my child to have a different mentor.
My child needs a mentor to be the same gender as he/she is.
My child needs on-going and consistent support and encouragement that mentoring provides.
My child needs and benefits from the extra attention one-on-one mentoring provides.
Mentoring helps my child's self esteem.
My child is “opening up” as a result of being mentored.
My child benefits from having a same gender role model.
My child has taken a more positive interest in school since being mentored.
I believe that having a mentor helps my child do better in school.
It’s good for my child to have another adult he/she can talk to.
"No" reasons...
My child didn’t seem very interested in being mentored.
I feel the time out of class has hurt my child academically.
My child is moving out of the area.
 
Other Comments:

Please consider how you feel the mentoring relationship has affected your child 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 - Reading
Academic Performance – Math
Academic Performance – Language Arts

Has there been any improvement in the child’s grades, in any school subjects, since the beginning of the school year? (Please choose)
Yes  No
If yes, in how many subjects have you observed an improvement in grades? (Please choose)
1     2     3     4 or more
Thank you for completing our survey.