Mentoring Conversation Survey

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* 1. Your Name and Location

Name

School

City/Town

State

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* 2. What was the topic of your mentoring conversation?

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* 3. Do you think your youth will apply the life skill that you talked about?

Yes

No

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* 4. For the Go Mentor Campaign participants (ALL OTHERS SCROLL DOWN AND CLICK DONE): What is the name of the person you had a mentoring conversation with?

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* 5. For the Go Mentor Campaign participants (ALL OTHERS SCROLL DOWN AND CLICK DONE): What is this person's cell phone number?

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* 6. For the Go Mentor Campaign participants (ALL OTHERS SCROLL DOWN AND CLICK DONE): What did the person learn from the conversation?