Male Mentor Program Assessment Form

* Required fields

Name *

E-mail Address *

Cell Phone *

Address *

What is the best time to reach you? *

Are you currently employed? *

Yes No

If so, what is your job title?

Father Name

Email

Cell Phone

Address

What is the best time to reach you?

Are you currently employed?

Yes No

If so, what is your job title?

Student Name *

Student Date of Birth *

Student Grade

Student Cell *

Student School *

Student School Counselor Name

Student School Counselor Email

Student School Counselor Cell

Student After-School Counselor Name

Student After-School Counselor Email

Student After-School Counselor Cell

Does the student have an IEP? *

Yes No

Does the student need extra time for reading, math, and/or English? *

Yes No

Student's favorite subject? *

Student's favorite hobby? *

Student's best skill? *

Is the student employed? *

Yes No

Does student need or want tutoring? *

Yes No

Does the student play school or club sports? *

Yes No

What is the student's favorite sport? *

Student on school or court supervision? *

Yes No

If employed, what is the job title?

Student on school or court probation? *

Yes No

As a parent, what areas do you think your child needs to improve on? *

As a student, what areas do you think you need to improve on? *

On a scale of 1-5, with 5 being the highest, how knowledgeable is your child about financial literacy? *

On a scale of 1-5, how much would you want your child to learn about earning money? *

On a scale of 1-5, how much would you want your child to learn about creating a budget? *

On a scale of 1-5, how much would you like your child to learn about owning a business? *

On a scale of 1-5, how much would you like your child to learn about mortgages? *

On a scale of 1-5, how much would you like your child to learn about real estate? *

On a scale of 1-5, how much would you like your child to learn about insurance? *

On a scale of 1-5, how much would you like your child to learn about taxes? *

On a scale of 1-5, how much would you like your child to learn about credit? *

Comments

I have read and agree to the Privacy Policy *