Mentee Interest Survey Form
We're excited that you're thinking about joining the Empowering Youth Mentor Program as a mentee! This is your chance to connect with a mentor who’s not only here to support and guide you, but also to build a meaningful friendship and share some fun experiences along the way. Your mentor will help you set goals, overcome challenges, and learn new skills—while also being someone you can hang out with and enjoy time together. To make sure we match you with the right mentor, we’d love to hear more about your interests, goals, and what kind of support you're looking for. Please take a few minutes to fill out this survey. Your responses will help us find a mentor who shares your interests and can help you grow, both personally and professionally, while also making the journey fun.
Name
First Name
Last Name
Age
Date
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What are the best times for you to meet with your mentor? Please check all that apply:
Weekdays
After School
Evenings
Weekends
Other
What are you looking for in a mentor?
Do you speak any languages besides English? If so, which ones?
What are your favorite activities to do with others?
What are your favorite subjects to study?
If you could learn about a job/career, what it would be?
What is one goal you have set for the future?
If you could learn something new, what would it be?
What person do you most admire and why?
Describe your ideal day:
Let's know some more things about you and your personality
What activities or hobbies do you enjoy in your free time?
Do you prefer indoor or outdoor activities?
Indoor
Outdoor
Both
What kind of creative activities do you enjoy?
Drawing, Painting, or Crafting
Writing or Journaling
Playing Musical Instruments
Other
Which sports or physical activities do you enjoy?
Do you enjoy playing games? If so, what kinds?
Video Games
Board Games
Puzzles
Other
What kind of books or movies do you like?
Adventure
Science fiction
Funny
Other
What do you like to do with your friends?
Play games
Go outside
Do creative activities
Other
What new activities would you like to try with your mentor?
Learn a new sport
Explore nature
Do a creative project
Other
How would you describe yourself when meeting new people?
Outgoing and Talkative
Quiet and Thoughtful
A mix of both
Other
What role do you think a mentor should play in your life?
A teacher and a guide
A friend and supporter
Someone to have fun with
Other
How do you like to solve problems?
I like to talk to someone for advice
I try to figure things out on my own
I ask for help when neeeded
Other
Do you enjoy spending time in social settings, or do you prefer quieter activities?
I like social settings and meeting new people
I prefer quieter, one-on-one activities
I enjoy a mix of both
Other
How do you feel about trying new activities?
I get exited to try new things
I am open to new experiences
I prefer familiar activities
Other
How do you like to communicate with others?
I like talking and sharing my ideas
I prefer to listen more than I speak
I enjoy both talking and listening
Other
What are you most exited to do with your mentor?
Trying new activities
Learning new skills
Talking and getting to know each other
Other
How do you think a mentor can help you grow?
By teaching me new things
By being there to listen and support me
By sharing fun and meaningful experiences
Other
What kind of personality do you think you'd get along with in a mentor?
Outgoing and Energetic
Calm and Thoughtful
Creative and Fun
What do you hope to learn from your mentor?
Life skills
New hobbies or activities
How to deal with challenges
Other
Submit
Should be Empty: