Mentee
Assessment
Plan

To be completed by teacher, counselor, or program staff most familiar with the menteeís career and personal interests.  This information will assist efforts to effectively match mentees with mentors.  Confidential information should not be disclosed without permission from the mentee.
 

Name of Mentee: _________________________________

Grade Level or Age:  _________

Name of Program/School: ___________________________

Staff Name:  _____________________________________

Describe type of mentor this youth wants:
 

Describe primary career interest/direction of the mentee:
 

Please indicate employment barriers this mentee faces:

Single Parent
Learning Disability
Foster Care
Teen Parent		 Pregnant Teen/Adult
Physical Disability
Transportation Issues
 		 Basic Skills Deficient
Protective Services
Economically Disadvantaged
 

Please rate the following statements on a scale of 1-10 with 10 being the highest:
      ___Interest in having a mentor
      ___Preparation for being matched with a mentor
      ___Motivation/Organization to keep appointments
      ___Overall preparation for career placement
      ___Motivation to complete their educational goals

Is there anything important we need to know about this person?
 

Please return this questionnaire to:
  Name
  Due Date