Parent / Guardian Information
Does your family receive income assistance?*
Does your family receive housing assistance (e.g. Section 8, residence in public housing?)*
Does your child receive free/reduced lunch?*
Do you have legal custody of the child?*
Mentoring Outcomes Survey
This section should be completed by the student personally. Please note that this information will remain confidential and will not influence your child's admission into the program.
On your most recent report card, which of these describes your grades in these subjects?
Social Studies / History*
Do you think you will finish high school?
Do you plan on attending college or trade school?
How often do you get in trouble for:
Bothering / not listening to my teacher.*
Not following directions.*
Breaking other people's things*
Lying to parents or teachers*
Taking something without permission.*
Skip school without permission*
Get high using prescription or illegal drugs or substances*
Not following directions.*
Get stopped by the police for something they thought you did.*
Work well with other kids at school.*
Get along with your parents.*
Keep your feelings from getting out of control.*
Control yourself when you get angry. *