Which Mentoring program are you from:* |
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Person completing this form:* |
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1) Self-confidence- A sense of being able to do or accomplish something* |
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2) Able to express feelings-Is able to reveal, talk about, or discuss feelings* |
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3) Can make decisions- Thinks before acting and is aware of consequences of behavior* |
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4) Has interests or hobbies-Pursues activities such as reading, sports, music, computers, etc* |
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6) Sense of Future- Knows about educational and career opportunities* |
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7) Uses community resources-Partakes in service activities, libraries, recreation, church/other faith-based activities* |
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8) Uses school resources-Uses the library, guidance counselors, and tutorial centers* |
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10) Attitude toward school-Is positive about going to school and about what can be learned* |
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11) School preparedness-Completes homework and other assignments* |
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12) Class participation-Actively takes part in learning; responds to questions* |
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13) Classroom behavior-Pays attention in class; isn't disruptive* |
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14) Able to avoid delinquency-Refrains from behaviors that are illegal for person of his/her age* |
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15) Able to avoid substance abuse-Does not use illegal or harmful substances(ex.drugs,alcohol,and tobacco)* |
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16) Able to avoid early parenting-Doesn't engage in sexual behavior likely to result in early parenting* |
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17) Shows trust towards you-Isn't reluctant to confide in you, to accept your suggestions* |
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18) Respects other cultures- Doesn't stereotype or put down other ethnic, racial,language,or national groups* |
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19) Relationship with family- Interacts well with other family members* |
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20) Relationship with peers-Interacts well with persons of own age* |
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21) Relationship with other adults- Has good interactions with other adults who are not family members* |
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22) Additional comments, questions, interests,and/or concerns........ |
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