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School-Based Group Mentee Wrap-Up

Post-Program Survey – School-Based Group Mentees

Caseworker Name(Required)

First Last

Please indicate the name of the group program(Required)

Go Girls!

Game On!

Other

Please enter the name of the school(Required)

Please enter the day of the week this program is delivered(Required)

Please enter the number of Mentees participating in this survey(Required)

Have you enjoyed the program?(Required)

Please enter the number of Mentees who replied Yes.

Has this program made you feel more confident?(Required)

Please enter the number of Mentees who replied Yes.

Have you learned new ways to address problems or issues with school, friends and family?(Required)

Please enter the number of Mentees who replied Yes.

Has this program helped you socialize and connect with others?(Required)

Please enter the number of Mentees who replied Yes.

Have you learned new strategies to help you manage stress?(Required)

Please enter the number of Mentees who replied Yes.

Did you learn any new ways to be physically active?(Required)

Please enter the number of Mentees who replied Yes.

Did you learn anything new about healthy eating?(Required)

Please enter the number of Mentees who replied Yes.

Do you have a more positive attitude towards school than you did before you started this program?(Required)

Please enter the number of Mentees who replied Yes.

Are more likely to take on leadership opportunities than you were before?(Required)

Please enter the number of Mentees who replied Yes.

Have you or would you join any other school activities since starting this program?(Required)

Please enter the number of Mentees who replied Yes.

Name something you may do differently in life after your experience in this group program.(Required)

What is 1 word that best describes your experience in this program?(Required)

Is there anything you would suggest adding, removing or changing from the program?

Please share any additional comments, questions or concerns you may have at this time.

Please rate the following on a Scale of 1-5

1 = Never and 5 = Almost Always Caseworkers: Enter the average number from all responses in the boxes below.

How often did your Mentors show you that you matter to them?(Required)

Express Care

Please enter a number from 1 to 5.

How often did your Mentors encourage you to be your best?(Required)

Challenge Growth

Please enter a number from 1 to 5.

How often did your Mentors make you feel supported?(Required)

Provide Support

Please enter a number from 1 to 5.

How often did your Mentors listen to your ideas and take them seriously?(Required)

Share Power

Please enter a number from 1 to 5.

How often did your Mentors show you new ideas and activities?(Required)

Expand Possibilities

Please enter a number from 1 to 5.

Phone

This field is for validation purposes and should be left unchanged.