Mentor/Mentee Questionnaire application

Applicant Name _______________________________ Age ____ Birthday Date _____________

Reference Name _________________________________ Phone Number __________________

The following name has been given to us as a reference for The New Hue mentoring program. This
program will assist in molding the child into a strong independent young man. Once the applicant
has been selected we will spend the day with him. During that day we will provide the young
gentleman with a haircut, his own tailored suit, a personal photo shoot along with a sit down
consultation with the members of The New Hue. We want to use this time to LISTEN to him. Find
out what he expects from his elders and what his elders expect from him.

I would like to ask you some questions about him, which will be held in absolute confidence; it will
not be shared or accessible to him.

1. How long, and in what capacity, have you known the applicant? ________________________

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2. How does the applicant relate to people in general? __________________________________

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3. How would you describe the applicant? ____________________________________________

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4. Do you feel that the applicant would benefit from The New Hue? ________________________

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5. Do you think that the applicant relates well to younger or older people? Why? _____________

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6. Does the applicant usually keep his commitments? __________________________________

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7. How does the applicant handle disappointment in his life? _____________________________

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8. To your knowledge, has the applicant ever been convicted of a crime? If so, what was the
nature of that crime? __________________________________________________________

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9. Would you feel comfortable allowing the applicant to spend a day with his mentors? _________