Mentor Interest Survey Please enable JavaScript in your browser to complete this form. - Step 1 of 3Youth's InformationNameFirstMiddleLastPlease complete all of the following. This survey will help Field of Hope Mentoring Program know more about you and your interests and help us find a good match for you.What are the most convenient times for you to meet with your mentee? Please check all that apply.LunchtimeAfter SchoolEveningsWeekendsOtherIf "other" is checked above, explain:Please indicate age group(s) you are interested in working with:11-14 years of age15-18 years of ageDo you speak any languages other than English? If so, which languages?Would you be willing to work with a child who has disabilities? If so, please specify disabilities you would be willing to work with.What are some favorite things you like to do with other people?What are your favorite subjects to read about?What is your job and how did you choose this field?What is one goal you have set for the future?If you could learn something new, what would it be?What person do you most admire and why?Describe your ideal Saturday.Please check all activities you are interested in:Animals/PetsBikingBoatingBoard GamesCampingCookingFishingGardeningGolfHikingLibraryMoviesMusicPainting/PhotosParksScienceShoppingSportsSwimmingYogaList any other areas of strong interest:NextAdditional InformationThe child is being referred for assistance in the following areas (check all that apply):Academic IssuesAttitudeBehavioral IssuesDelinquencyFamily IssuesPeer RelationshipsSelf-EsteemSocial SkillsSpecial NeedsStudy HabitsVocational TrainingOtherWhy do you feel this youth might benefit from a mentor?What particular interests, either in school or out, do you know that the child has?What strategies/learning models might be effective for a mentor working with this youth?NextYouth AssessmentAcademic Performance Selected Value: 0 Social Skills Selected Value: 0 Self-esteem Selected Value: 0 Family Support Selected Value: 0 Communication Skills Selected Value: 0 Attitude About School/Education Selected Value: 0 Peer Relations Selected Value: 0 With what specific academic subjects, if any, does the student need assistance?Additional Comments:EmailSubmit
