Your Name *

First Name

Last Name

Potential Mentor Name *

First Name

Last Name

How long have you known the prospective mentor? *

<1 year

1-2 years

2-3 years

3+ years

How would you rate the potential mentor's ability to work with and relate to children? *

Above satisfactory

Satisfactory

Below satisfactory

We are looking for someone who can remain patient and communicate a lesson even it becomes frustrating. How would you rate the prospective mentor’s ability to be patient? *

Above satisfactory

Satisfactory

Below satisfactory

How would you rate the prospective mentor's ability to relate with adults? *

Above satisfactory

Satisfactory

Below satisfactory

We need a person who can be supportive and understanding to a child or student. How would you rate the prospective mentor's ability to be genuinely supportive and understanding to a student in need? *

Above satisfactory

Satisfactory

Below satisfactory