The document describes the enrollment and survey tools used for a mentoring program. It includes: - A student application and parent consent form to enroll students in the program. - A pre-survey given to students to collect data on their supportive relationships, school engagement, attitudes, and coping strategies. This information helps tailor the program to individual students' needs. - Post-surveys are also given to students, mentors, and parents to provide feedback on the program and identify areas for improvement. - Example questions are provided for each category in the pre-survey to assess students' relationships, engagement, behaviors, and ways of coping.

1. ENROLLMENT
AND
SURVEY TOOLS

2. Enrollment and Pre-Survey
• Student application
• Parent Consent
- Showcase the program through the brochure
- Signed consent form
• Pre-Survey
- Data collection to help concentrate on individual’s
needs and that can be used as a measure
- Supportive Relationships
- School Engagement
- Attitudes and Behaviors
- Ways of Coping
- No “correct” or “incorrect” answer
- Ratings

3. Examples of Survey Questions
• Supportive Relationships (parents, teachers, relatives, friends,
etc )
Helps identify child’s interaction with adults and presence
- Do you have adults offer advice and help with personal problems?
- Do you have adults that encourage and motivate you ?
- “T” point : Teamwork, Temple, Talking
• School Engagement
Helps identify any issues child is facing at school
- How often are you able to complete school assignments?
- Are you paying attention in class ?
- “T” point: Taking Tests, Time management

4. Examples of Survey Questions
• Attitudes and Behaviors
Helps identify child’s personality
- Do you accept responsibility for your actions ?
- Do you do what you believe in ?
- “T” point: Teamwork, Talking, Talent
• Ways of Coping
Helps identify child’s coping techniques in difficult situation
- Do you act hastily when in difficult situation?
- Do you see things from the other person’s point of view?
- “T” point: Taking a stand, Taking charge

5. Program Survey
• Post-Survey by Mentees
- Categories included in Pre-survey
- Feedback about Mentors
- Feedback about Program
• Survey by Mentors
- Feedback on schedule and activities ?
- What can be done better ?
• Survey by Parents
- Has the child shown improvements ?
- Improvements to current program ?
• References : Mentoring.org

6. Appendix – Pre Survey Template
PRE-PROGRAM SURVEY
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!
Your Name: __________________________________________ Date: __________________________
Unless indicated, please CHECK ONLY ONE BOX per item.
Supportive Relationships
How many adults in your life (parents, teachers, counselors, None One 2–3 4–5 6 or
relatives, friends, etc.) do the following things for you? more
a. Offer help with schoolwork?
b. Say something nice when you do something good?
c. Pay attention to what’s going on in your life?
d. Offer help in an emergency?
e. Offer advice about personal problems, such as a problem with
a friend?
f. Offer help if you were really upset or mad?
School Engagement
How often are the following true for you? Never Sometimes Often Very
Often
a. I pay attention in class.
b. I often come to class unprepared.
c. I don’t try very hard in school.
d. I work very hard on my schoolwork.
e. I am able to complete my school assignments on time
f. I have a planned schedule that I follow to manage my time
g. Doing the best I can in school.
Attitudes and Behaviors
How important is each of the following to you in Not At Somewhat Important Very
your life? All Important Important
a. Getting along with my friends/team mates
b. Doing what I believe is right, even if my friends
make fun of me.
c. Standing up for what I believe, even when it’s
unpopular to do so.
d. Telling the truth, even when it’s not easy.
e. Accepting responsibility for my actions when I
make a mistake or get in trouble.
f. Doing my best even when I have to do a job I
don’t like.

7. Appendix – Program Survey Templates (Cont’d)
We would like to have your opinion of the Total Package program so that we may
evaluate and strengthen our program for the future. Please complete the questions
below and return the survey to the program coordinator. (Please circle your response)
1. How would you rate the mentor program?
Excellent very good good poor
2. Did you enjoy being part of this program?
Yes mostly not much no
3. Would you want to continue in the program next year?
Yes probably not really no
4. Did participating in this program help you do better in school?
Yes mostly not much no
5. Did participating in this program help improve your attitude or personality?
Yes mostly not much no
6. Did you learn new things from your time in the program?
Yes mostly not much no
7. List some of the activities you did in the mentorship program:
8. Was the schedule convenient?
9. Which of the T-points proved more useful and how/why?
10. Are there any specific T-points that you would have liked to spend more time on
or emphasized on?
11. How do you rate the guest speakers?
Excellent very good good poor
12. Would you suggest including any specific guest speakers ?
13. What do you think we should change or do differently next year?
14. Are there any other T-points you would like to be included for future?

8. Appendix – Parent Survey Template (Contd)
Thank you for your support and interest in the Total Package Program. In order to find ways to make the
program better, we ask you to take a few moments to complete this survey. Your input will be greatly
appreciated.
Date: _________________
Your Name _______________________ Child’s Name _______________
1. Has your child been in a mentorship program prior to this?
Yes No
2. Does your child seem as if he or she enjoys the time spent in the mentorship activities?
Yes No
3. Does your child (please check all that apply):
1. Seem happier? Yes No
2. Seem less angry? Yes No
3. Get along better with brothers/sisters? Yes No
4. Get along better with friends? Yes No
5. Listen better? Yes No
6. Feel better about him/her? Yes No
7. Work harder on homework? Yes No
8. Seem more responsible? Yes No
9. Have better school attendance? Yes No
10. Seem better behaved at home? Yes No
11. Do better in school? Yes No
12. Seem better behaved at school? Yes No
13. Have a better attitude about school? Yes No
4. What do you think are the greatest benefits your child will (has) receive as a result of having
participated in the Total Package mentorship program?
5. What would you suggest as a possible activity for mentors, mentees and their families?