Mentoring Feedback Survey
Complete this with your spouse
We want to make sure that we are staying in touch. Our prayer is that you have a great connection with your couple and that you feel supported during this journey with them. Please fill out this feedback form about your meeting yesterday.
Mentor Info
First Name
Last Name
Email
Spouse First Name
Spouse
Last Name
Spouse
Email
Mentee Info
First Name
Last Name
Email
Partner
First Name
Partner
Last Name
Partner
Email
When was your most recent session?
What meeting is this with this couple?
1st meeting
2nd meeting
3rd meeting
4th meeting
5th meeting
6th meeting
other
How much time did you spend meeting with this couple?
Please select...
0:00
0:15
0:30
0:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
7:00
8:00
9:00
10:00
Which assessment pages did you cover with your mentees in this meeting?
SYMBIS page 1
SYMBIS page 2
SYMBIS page 3
SYMBIS page 4
SYMBIS page 5
SYMBIS page 6
SYMBIS page 7
SYMBIS page 8
SYMBIS page 9
SYMBIS page 10
SYMBIS page 11
SYMBIS page 12
SYMBIS page 13
SYMBIS page 14
SYMBIS page 15
SYMBIS page 16
What homework did you cover last night?
no homework
Financial Profile
Time Worksheet
His/Her Sexual Expectations
Discussed SYMBIS book Chapters 1 & 2
Discussed SYMBIS book Chapter 4
Discussed SYMBIS book Chapters 3 & 5
Discussed Complete Monthly Cash Flow Plan
Discussed "Heart Talk"
Discussed "Crazy Cycle" and Tips for Fighting Fair
Discussed "Four Changes to Improve Connection"
Discussed "Fighting the Little Foxes - 10 Cures for Conflict"
What could we do to make your mentoring sessions better?
How much time did you spend preparing for this meeting?
Please select...
0:00
0:15
0:30
0:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
7:00
8:00
9:00
10:00
What is the date of your next meeting so that we can be praying for you?
What would you like us to know about your mentoring session from last night?
Would you like someone from CenterPeace to contact you for any reason?
Please select...
Yes
Not at this time
Contact Information