Youth Interview Questions

Tutor/Mentor - Child Interview Notes

Child Name

Date

Interviewer:

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

D.O.B.

School

Age

Grade

Family & Siblings

Favorite Memory

Is/Isn't in contact with Biological family

Currently Lives With

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?

6 months

Personal Goal

Academic Goal

1 year

Personal Goal

Academic Goal

Grade Portal Site:

User ID:

Password:

School Subjects Needing Help In:

Additional Notes/Observations