CB 1:1: - 4 Month Survey - Caregiver

Thank you for taking the time to complete our survey! Your answers will help us understand more about mentoring relationships and assist us in improving future programming.

Please remember that there are no right or wrong answers; this is not a test. We would just like to know how you are doing; so please feel free to be honest. Any information you provide to us, in connection with this evaluation, will remain confidential. We value your privacy and we will never share your name or individual answers with anyone. We will combine all survey responses together to find overall trends and suggestions for improving our program.

The survey will take approximately 5 minutes to complete.

Name(Required)
Child's Name(Required)
Please select the name of your Caseworker(Required)
Where do the majority of activities take place?(Required)
Have you had any concerns with the following? (Please check all that apply)(Required)
How does the Mentor communicate with you?(Required)
Do your child and their Mentor communicate between visits?(Required)
How often does your child see their Mentor?(Required)

Do you feel the outings are consistent?(Required)
Are you aware of any safety issues that have come up during an outing or activity? (Please check all that apply)(Required)
This field is for validation purposes and should be left unchanged.