Mentor Matching Survey Question Title * 1. Full name: Question Title * 2. Email: Question Title * 3. Phone number: Question Title * 4. Address: Address Address 2 City/Town State/Province ZIP/Postal Code Question Title * 5. How would you describe your gender? Male Female Enter your own: Question Title * 6. How would you describe your racial/ethnic background? (Check all thatapply) Black non-Hispanic American Indian or Alaskan Native Asian or Pacific Islander Hispanic White non-Hispanic Unsure/Don't know Prefer not to answer Enter your own: Question Title * 7. Education: High School Diploma GED Trade/Tech School Attended College Associate Degree Baccalaureate Degree Master's Degree PhD Question Title * 8. Occupation: Question Title * 9. Personal Interests/Hobbies Question Title * 10. Which of the following best describes your personality? Extrovert: Responds to situations quickly with sustained intensity. (Bold, Task Oriented, Active, Excitable, Aggressive, Impulsive, Changeable, Optimistic, Excitable, Restless, Can Be Touchy) Introvert: Responds to situations slowly with short and mild intensity. (Quiet, Relationship Oriented, Calm/Passive, Even-Tempered, Controlled, Hopeful, Reliable, Peaceful, Thoughtful) Extrovert: Responds to situations quickly with short and mild intensity. (Bold, Relationship Oriented, Sociable, Talkative, Lively, Carefree, Responsive, Outgoing, Leadership, Easygoing) Introvert: Responds to situations slowly and with sustained intensity. (Quiet, Task Oriented, Reserved, Sober, Rigid at Times, Serious, Worried, Thoughtful) Question Title * 11. From the following list, please choose your top 5 Core Values: Citizenship Compassion Cooperation Courage Authenticity Faith Health & Fitness Honesty Perseverance Trustworthiness Positive Attitude Resourcefulness Respect Responsibility Service Kindness Gratittude Fairness Generosity Question Title * 12. Why did you decide to become a mentor? Question Title * 13. Which of the following would you register as your strengths as a Foster Parent? Organization, Paperwork, & Documentation Communication with Social Workers & Community Partners Working with Birth Parents Understanding and Managing Child Behaviors Finding Community Resources to Meet the Needs of Children Routine, Structure, & Home Management Transracial Parenting Managing Expectations and Emotions Understanding Cognitive Delays Understanding Emotional/Behavioral Challenges Addressing Attachment Challenges Trauma-Informed Caregiving Addressing Grief and Loss Partnering with Schools (IEP, ARC, 504 Plans, etc.) Managing Sexually Acting Out Dealing with Court Proceedings & Legal Supports (GAL, CASA) Transitioning Children to/from Home Question Title * 14. Which of the following best describes your hopes for mentees during a match? Become confident in new role as a foster parent Become knowledgeable about community resources Learn who to contact when they have questions Know they are not alone on their foster parent journey. Apply skills learned during initial training Provide emotional support and encouragement Enter Your Own: Question Title * 15. Which of the following motivated you to serve as a Foster Parent? Desire to adopt a child(ren) Desire to help children in need Felt moved by my religious beliefs to provide a safe home for children Enter your own: Question Title * 16. How many years of service do you have with foster care? 1 year - 3 years 4 years - 8 years 9 years - 12 years 13+ years Question Title * 17. How would you describe your family's mission? Question Title * 18. Please share your adoption experience (if applicable). How many children have you adopted, was it one child or a sibling group? Have you adopted several times? How would you describe your overall adoption experience (challenging, difficult, rewarding, etc.)? Question Title * 19. Describe your experience with relative/kinship care (if applicable). Question Title * 20. What is your foster parent story? Question Title * 21. Please share your best foster parent "Pro Tip" or your best piece of advice for new foster parents. Question Title * 22. In what languages are you fluent? English Spanish American Sign Language Question Title * 23. For what age range(s) have you had experience with children in foster care? Birth - 5 years 6 years - 12 years 13 years - 18 years Question Title * 24. For what gender(s) are you best suited to offer support and training? Male Female Enter your own: Question Title * 25. For what ethnic background(s) have you had experience with in foster care? Black non-Hispanic American Indian or Alaskan Native Asian or Pacific Islander Hispanic White non-Hispanic Unsure/Don't Know Enter your own: Question Title * 26. For what stressor(s) are you best suited to offer support and training? ADHD Behavioral Issues Drug Exposed Emotional Disorders Fetal Alcohol Gang Issues Independent Living Medically Complex Mentally Challenged Neglected Physically Abused Physically Challenged Sexual Orientation Sexually Abused Suicide/Depression Unsure/Don't know Question Title * 27. List any areas for which you do not feel comfortable offering support and training: Question Title * 28. Just for fun, what are your favorite pizza toppings? Question Title * 29. What is your DCBS Service Region? Cumberland Eastern Mountain Jefferson Northern Bluegrass Northeastern Southern Bluegrass Salt River Trail The Lakes Two Rivers Done