Annual Check-in Survey for Big Buddies

Your Name:*

Little Buddy's Name:*

Your Case Manager's Name:*

Today's date:*

1. How do you feel your relationship is developing?

Not very well
Fairly well
Very well

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

Not connected
Fairly conntected
Very connected

3. How consistent have you been in getting together with your Little Buddy?

Not consistent at all (once a month or less)
Somewhat consistent (twice a month)
Very consistent (3-4 times a month)

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

Never
Occasionally
Every outing

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

6. 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?

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. Have you received quality and helpful support from the Buddy Program?

Never
Occasionally
Very often

10. In regards to question #9, if you selected NEVER or OCCASIONALLY, have you felt you needed or wanted more support?

Yes or no? Have you ever asked for it? *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 Manager, Ainhoa Bujan at 970.373.4850 or [email protected] OR Program Director, Brooke Bockelman at 970.317.2836 or [email protected]

11. Are you mentoring to your full potential?

Yes or no? Please elaborate.

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

Yes or no? Please elaborate.

13. 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?

14. 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.

Any additional comments:

Annual Check-in Survey for Big Buddies

Annual Check-in Survey for Big Buddies

Top Sponsors