MYM - Program Outcome Evaluation


Mentor Name:*
Mentee Name:*
Which Mentoring program are you from:*

Person completing this form:*

1) Self-confidence- A sense of being able to do or accomplish something*

2) Able to express feelings-Is able to reveal, talk about, or discuss feelings*

3) Can make decisions- Thinks before acting and is aware of consequences of behavior*

4) Has interests or hobbies-Pursues activities such as reading, sports, music, computers, etc*

5) Personal hygiene/appearance-Dresses appropriately and keeps self-neat & clean*

6) Sense of Future- Knows about educational and career opportunities*

7) Uses community resources-Partakes in service activities, libraries, recreation, church/other faith-based activities*

8) Uses school resources-Uses the library, guidance counselors, and tutorial centers*

9) Academic performance-Makes good grades or improves grades*

10) Attitude toward school-Is positive about going to school and about what can be learned*

11) School preparedness-Completes homework and other assignments*

12) Class participation-Actively takes part in learning; responds to questions*

13) Classroom behavior-Pays attention in class; isn't disruptive*

14) Able to avoid delinquency-Refrains from behaviors that are illegal for person of his/her age*

15) Able to avoid substance abuse-Does not use illegal or harmful substances(ex.drugs,alcohol,and tobacco)*

16) Able to avoid early parenting-Doesn't engage in sexual behavior likely to result in early parenting*

17) Shows trust towards you-Isn't reluctant to confide in you, to accept your suggestions*

18) Respects other cultures- Doesn't stereotype or put down other ethnic, racial,language,or national groups*

19) Relationship with family- Interacts well with other family members*

20) Relationship with peers-Interacts well with persons of own age*

21) Relationship with other adults- Has good interactions with other adults who are not family members*

22) Additional comments, questions, interests,and/or concerns........
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