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Million Mentors
Program Evaluation
Partners Worldwide - Million Mentors Program
Survey Questionnaire
For Employees of Association Businesses
Section A: General Information and Background
1. What is your name?
Enter
[none]
for no response
2. What is your age?
years
Enter 999 for no response
3. What is your marital status?
Single
Married
Divorced
Widowed
no response
Please choose one
4. How many children are in your family?
Enter 999 for no response
5. How many others are dependent on you?
Enter 999 for no response
6. How many years of formal education have you had?
Enter 999 for no response
7. What is your religious affiliation?
Enter
[none]
for no response
8. What is your average annual family income?
Below $1000
$1000-$2000
$2000-$4000
$4000-$6000
Above $6000
no response
Section B: Assessment of Impacts
9. How long have you worked in this job?
years &
months
10. What did you do for work before you had this job?
Enter
[none]
for no response
Optional Interviewer Comments:
If you would like to give details related to any response on page 1, please do so here.