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PRE-POST TEACHER SURVEY

Thank you for your interest in this mentoring program. The program involves gathering information to assist the project in future years. Kindly take a few minutes to complete this survey for the student whose name appears below. Mark your answers based on your own professional judgment at this particular point in the school year. Return the survey to your principal no later than __________________. Thank you for your help.

Teacher ____________________

Student ____________________________

Check the appropriate column in each category for the student whose name appears above:
Personal Growth: Self-control Cooperation Responsibility Self-confidence Classroom participation Interaction with teacher Interaction with other children Communicates clearly Handles conflict Appearance Behavior Work Habits: Listens attentively Follows directions Completes tasks Attendance Tolerates frustration Academics: Interest in reading Interest in writing Interest in spelling Interest in mathematics Academic mastery in reading Academic mastery in writing Academic mastery in spelling Academic mastery in mathematics Excellent Good Some Little None Dont Know

Courtesy of Dr. Susan G. Weinberger, president, Mentor Consulting Group.

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