This survey will help us learn about you and the other youth who are participating in the mentoring program. It is
important for us to learn as much as we can about what you get out of your participation and how we can improve
the program to make it even better next year. It is important that you answer each question as honestly as you can.
Remember that there are no right or wrong answers, so please do not answer the questions based on what you think
we want to hear. Only the program coordinator will see how you answer the questions and he or she will keep your
answers confidential. Thank you for taking this survey and helping us evaluate the program!
Unless indicated, please CHECK ONLY ONE BOX per item.
How many adults in your life (parents, teachers, counselors,
relatives, friends, etc.) do the following things for you?
How often are the following true for you?
ATTITUDES and BEHAVIORS
How important is each of the following to you in
WAYS OF COPING
When you’re faced with a problem or difficult
situation, how likely are you to do the following?