Amachi Pittsburgh Youth Survey
There are no right or wrong answers. We just ask that you answer the questions as truthfully and completely as possible. If you do not want to answer a question, you can leave it blank. However, all of your answers will be kept private. They will not be shared with your parent/guardian, teacher, or mentor, and they will not be used to decide whether you get a mentor. If you do not understand the meaning of a question, you can ask an Amachi Pittsburgh staff person to help you.
if staff person assists with survey completion
School
Please think about the grades and marks that you are getting in school. We would like to know how you are doing in each of the following subjects. For each subject area, please choose the response for Not Good at All (F), Not so Good (D), Good (C), Very Good (B), and Excellent (A).
Think about your school attendance in the past 30 days. Choose the response that corresponds to how often you have done each of these things. If it is the summer, think about the last thirty days that you were in school.
Emotional Well Being
For each item below, please choose the response that corresponds most to how you felt over the last month.
Self-Confidence
These questions ask about how you feel about yourself and other youth. For each item below, please mark the box that best corresponds to how you feel.
Personal Behaviors & Activities
These next questions ask about some behaviors and activities that you might have done in the past 30 days or 12 months. Choose the response that corresponds to how often you have done each.
Social Behavior
For each item below, please choose the response that corresponds to how you felt over the last month.
Family Relationship
Listed below are statements about families. Please read each statement and indicate your level of agreement to the statement. For each item below, please choose the response for Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, or Strongly Agree.
Facing Challenges: To what extent is each of the following statements like your family?
Communication: To what extent is each of the following statements like your family?
Celebrating Our Family: To what extent is each of the following statements like your family?
Special Adult
Please answer the following question(s) about a special adult in your life. A special adult is someone who does a lot of good things for you and who is not a parent or guardian. For example, someone (a) who you look up to and encourages you to do your best, (b) who really cares about what happens to you, (c) who influences what you do and the choices you make, and (d) who you can talk to about personal problems, could be considered a special adult.
Check all that apply. To select multiple options, click and hold Control.
A 'non-Amachi' mentor is a mentor that you are matched with through a different organization or program.
Mentor/Mentee Relationship
Every mentor/mentee relationship is unique, so each has a different approach. Please help us understand your mentee/mentor relationship by choosing a number from the scale-never important (1) to always important (6). How important do you consider the following focus areas in your mentoring relationship?
How do you feel about your match?
Please choose the response that corresponds to how much you agree or disagree with the following statements. The scale is from completely disagree (1) to completely agree (6).
Overall Reflections