Sample Mentoring Needs Assessment Form



SAMPLE MENTORING NEEDS ASSESSMENT FORM

|Targeted Youth Needs |Details of Issues In Your Club |Details of Issues In Your Community |

|Antisocial Behavior: A pervasive pattern of behavior that disregards or violates | | |

|the rights of others, societal mores or the law. Such behaviors include | | |

|deceitfulness, irritability, consistent irresponsibility, lack of remorse and a | | |

|failure to conform to social norms. | | |

|Family Problems | | |

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|Social Competence: The ability to achieve personal goals through social | | |

|interaction while maintaining positive relationships across time and different | | |

|situations. Self-reporting or staff ratings are the preferred data sources.  | | |

|Gang Involvement | | |

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|Alcohol and Drugs | | |

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|School Attendance | | |

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|High School Graduation | | |

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|Low Grade Point Average | | |

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|Perceived Access to Social Services/Support | | |

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|Pressing Community Needs |Details of Issues In Your Club |Details of Issues In Your Community |

|Career Opportunities | | |

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|Poverty Relief | | |

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|Changing Demographics | | |

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|Employment/Job Training | | |

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|Access to Higher Education | | |

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|Access to Social Services | | |

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|Crime Reduction | | |

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|Other Youth Service Providers |Details of Their Services |

|In Your Community |and Target Population |

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1. What needs have been expressed by youth in your Club?

2. What organizations, groups and individuals are already stepping up to help youth in your area?

3. Where are the gaps in services to the youth in your community?

4. Where are the gaps in services to the youth in your Club? For example, is there a need for role models who are minority males, successful businesswomen or Asian-American?

5. If you could change one thing for the better for your youth, what would it be?

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