KINNECTYOUTH Program Participant Survey
Welcome to the KINNECTYOUTH Mentoring Program for Black Youth. I hope you are just as excited as we are to get started. Please answer the following questions. The information collected in this survey will be kept confidential. It will ONLY be used for development and evaluation of the program and for additional supports for the participants. Thank you very much.
Email address *
Please provide your first and last name *
Your answer
Please provide your contact telephone information (cell phone # and/or home phone #)
Your answer
Please indicate your age below. *
Please indicate how you will arrive to the program. *
Approximately, how many credits have you earned so far?
Your answer
When is your birthday? *
MM
/
DD
/
YYYY
What grade are you in? *
If you are still in high school, how many community service hours have you earned so far? *
What do you love to do most in your spare time? *
Your answer
We will be preparing food at this program! What is your favourite meal?
What is your dream job? *
Your answer
ON a scale from 1-10, how would you rate your overall knowledge of black history and culture? *
I know a little bit
I know a lot
On a scale of 1-10, how much do you know about money management, savings and investments. *
nothing at all
quite a lot
On a scale from 1-10, rate your overall confidence and self esteem. *
high
low
Do you currently have a caring adult mentor who you can trust and call on for support? *
What are your expectations of the program? What activities do you want us to try? What are you interested in learning about? *
Your answer
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