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Youth Interview Questions
Name
Tutor/Mentor - Child Interview Notes
Child Name
*
Date
Interviewer:
FAVORITES:
Color
T.V. Program or Movie
Favorite Teacher
For Fun Activities
Dislikes
Pets
Music
Food
Sports
Favorite/Lucky #
Other likes
Fast Food
Zoo Animals
Actors & Singers
HISTORY:
D.O.B.
School
Age
Grade
Family & Siblings
Favorite Memory
Is/Isn't in contact with Biological family
Currently Lives With
WANTS/GOALS:
Career
What I like about myself:
If I had a million dollars?
Wants to go on vacation to:
3 Ways You Can Benefit From Having a Mentor:
What is one thing you would like your mentor to know about you?
MENTEE GOALS
6 months
Personal Goal
Academic Goal
1 year
Personal Goal
Academic Goal
GRADES
Grade Portal Site:
User ID:
Password:
School Subjects Needing Help In:
Additional Notes/Observations