Mentor Post Assessment

Form Approved OMB No. 0990-XXXX Exp. Date XX/XX/XX11

MENTOR POST-ASSESSMENT
Instructions: Your answers to these questions will help us improve our program.
Thank you for your help!

Section One: The Sponsoring Organization
1. Did the sponsoring organization provide you with mentoring training?
❏ Yes (please answer question 1A)
❏ No (please skip to question 2)
1A. How would you describe the mentoring training that was provided by the
sponsoring organization?
❏ Excellent

❏ Good

❏ Fair

❏ Poor

2. How often did you receive the information and support you needed from the
sponsoring organization?
❏ Always
❏ Most of the time
❏ About half the time
❏ Almost never
❏ Never
3. How would you rate the sponsoring agency’s overall ability to run this program?
❏ Excellent

❏ Good

❏ Fair

❏ Poor

4. How satisfied were you with the "match" between you and the mentee selected by the
sponsoring agency?
❏ Really satisfied
❏ Somewhat satisfied
❏ Somewhat dissatisfied
❏ Very dissatisfied
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0990- XXXX. The time required
to complete this information collection is estimated to average XX hours or xx minutes per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have
comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department
of Health & Human Services, ASRT/OCIO/PRA, 200 Independence Ave., S.W., Suite 531-H, Washington D.C. 20201, Attention: PRA
Reports Clearance Officer.

Section Two: Your Mentee
5. What kinds of physical activities did you do with your mentee? (Please check all that
apply)
❏ Organized sports together, like basketball or baseball
❏ One-on-one physical activity (such as walking together, biking, exercising together, playing frisbee or tossing a ball, swimming together, etc.)
❏ We talked to each other
❏ We discussed ways to be more physically active
❏ We discussed good nutritional practices
❏ We ate together
❏ I told my mentee stories about my struggles and successes
❏ I helped my mentee find a doctor or dentist or other medical referrals
❏ I helped my mentee find recreational activities and resources
❏ Other (please describe):
_______________________________________________________________________
6. What types of nutrition-related activities did you do with your mentee? (Please check
all that apply)
❏ We looked at information on good nutritional habits (e.g., on the web, in magazines, at
the library, etc.
❏ We prepared meals together
❏ We went to a nutrition class
❏ We provided written educational materials about nutrition to youth and children participating in the program
❏ I provided guidance and support to my mentee on healthy nutrition and good nutritional
choices
❏ Other (please describe):
_______________________________________________________________________
7. How often did you meet in person with your mentee?
❏
❏
❏
❏
❏

More than once each day
About once a day
A few times each week
Once a week
Less than once a week

8. How often did you communicate with your mentee by phone or computer?
❏
❏
❏
❏
❏

More than once each day
About once a day
A few times each week
Once a week
Less than once a week

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9. For each question, please check one box for the response that most closely matches
what you observed about your mentee during the course of being involved in the
program.
9A. Did your mentee's interest in physical activity and sports:
❏ Decrease

❏ Increase

❏ No change

❏ I don’t know

9B. Did your mentee's interest in making good nutritional choices:
❏ Decrease

❏ Increase

❏ No change

❏ I don’t know

9C. Did your mentee's overall physical fitness:
❏ Decrease

❏ Increase

❏ No change

❏ I don’t know

Section Three: The Program
10.

Why did you decide to participate in this program? (please check all that apply)
❏ I think physical activity is critical and wanted to support a program with this focus
❏ In addition to motivating the mentee to increase his or her physical activity, I thought this
might motivate me to increase my physical activity
❏ I think good nutrition is critical and wanted to support a program with this focus
❏ In addition to motivating the mentee to increase his or her good nutritional habits, I
thought this might motivate me to increase my good nutritional habits.
❏ I thought I could be a role model and help a youth with a disability
❏ I know the agency that sponsors the program and wanted to support their work
❏ When I heard about it I thought it sounded like fun
❏ Other (please describe):
___________________________________________________________________
______________________________________________________________ ____
______________________________________________________________ ____

11.

How much of a problem was transportation in face-to-face meetings with your
mentee?
❏ Not at All

12.

❏ A Little Problem

❏ A Big Problem

Did you and your mentee complete the entire eight weeks of the program?
❏ Yes (please skip to question 13)
❏ No (please answer question 12A)

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12A.

Why didn’t you complete the entire eight weeks of the program? (please
check all that apply)
❏ The mentee discontinued the program
❏ I didn’t like it
❏ I didn't get the support I needed from the sponsoring agency
❏ I didn’t feel adequately trained for the program
❏ My mentee and I just didn’t relate well
❏ It was harder than I thought it would be
❏ I couldn't think of enough things to do with my mentee
❏ I had health issues that made it impossible to continue
❏ I had work issues that made it impossible to continue
❏ Other (Describe):
______________________________________________________

13. Which one of the following best describes your experience with the program?
❏ I really liked it
❏I mostly liked it
❏ It was just okay; I didn’t really like or dislike it
❏ I really didn’t like it that much
❏ I really disliked it
14. What do you think could be done to improve this program? (Please check all that apply)
❏ There should be more guidance about what to do with mentees
❏ The should be more materials available about the benefits of physical activity
❏ There should be more materials available about making good nutritional choices
❏ There should be more involvement by parents
❏ There should be opportunities to connect with other mentors
❏ There should be activities where you can get to know other mentor/mentee pairs
❏ Other (please describe):

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15. Do you have any other comments about the program?

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