Annual Check-in Survey for Big Buddies

Your Name:*

Little Buddy's Name:*

Your Case Manager's Name:*

Today's date:*

Years matched with your buddy:*

1. How do you feel your relationship is developing?

Not well
Ok
Well
Very well

2. How connected do you feel with your Little Buddy?

Not connected
Sort of connected
Fairly connected
Very connected

3. How often do you and your Little Buddy get together?

Less than once a month
Once a month
Twice a month
Three or four times a month

4. How often do you spend time with your Little Buddy at your home?

Never
Rarely
Occasionally
Every outing

If you do spend time with your Little Buddy at your home, what are some of the activities you do there?

5. Do you think your Little Buddy has gained or learned from your relationship?

Yes or no? If yes, in what ways? If no, why not?

6. What have you gained or learned from your relationship?

7. What is a success you have had with your Little Buddy?

8. What is a challenge, big or small, that you have experienced?

How did you respond to that challenge/s?

9. When you have needed it, have you received quality and helpful support from the Buddy Program?

Yes or not? *Please know that if you don't feel comfortable asking for support from your case manager, you are always welcome to reach out to the Community Program Director, Ainhoa Bujan at 970.373.4850 or [email protected] OR Program Director, Brooke Bockelman at 970.317.2836 or [email protected]

10. Are you mentoring to your full potential?

Yes or no? Please elaborate.

11. Do you and your Little Buddy discuss goals, dreams, and aspirations?

Yes or no? Please elaborate.

12. Over the past year, have you set goals for your relationship with your Little Buddy?

Yes or no? If yes, what are some of those goals and have you found success in reaching those goals?

13. Do you and your Little Buddy discuss difficult topics (such as, but not limited to, peer pressure, bullying, problems at home)?

Yes or no? If yes, please expand as much as possible.

14. Do you want to continue your commitment as a mentor to your Little Buddy? Is there anything that makes you hesitant to continue your mentoring relationship? If you want to continue, what would you like to change, improve, or build upon in your relationship over the coming year?

15. What is a goal that you would like to set for yourself as mentor for the next year?

16. Could you integrate parallel goal setting into your relationship as a way to role model goal setting, encourage each other, and hold each other accountable as you work toward reaching your personal goals?

Any additional comments:

Annual Check-in Survey for Big Buddies

Annual Check-in Survey for Big Buddies

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