Mentor Candidate

	Court Services and Offender Supervision Agency for the District of Columbia
Faith-Based Re-Entry Initiative Mentor Candidate Questionnaire

1. Demographics

Name: Age: Gender: Marital Status:
Address:
Church:

2. Education and Employment

* What is the highest level of education you completed?

* Do you have any tutoring experience? Yes No

If yes, for adults, adolescents, or children? In which subjects?

* Are you currently employed? Yes No (if yes, indicate if part-time or full-time) If not, are you retired?

* How long have you been working at your current job? (OR How long did you work at your job?)

* What type of work do you do? (OR did you do?)

* How long have you been doing this type of work? (OR how long did you do?)

* Have you ever owned your own business? Yes No

* What sort of business is (or was) it? How long did you operate it?

* Have you ever helped anyone start a business? Yes No

3. Social and Residential Stability

* How long have you lived at your current address?

* How many times have you moved in the past 5 years?

* Who are the members of your household?

* Do you have children? Yes No

* How would you describe your relationship with your family?


* Are you involved in other volunteer activities in the community? Yes No

* How many close friends do you have?

* How long have you known your closest friend?

* How often do you see someone you would categorize as a close friend?

* Are you currently involved with a life partner? Yes No

* How long have you been with your partner?

4. Substance Abuse and Mental Health

* Are you in recovery from substance abuse? Yes No If so, for how long?

* Is your problem with drugs, alcohol, or both? How long have you abstained from substance abuse?

* Is any of your immediate family in recovery from substance abuse? Yes No If so, for how long?

* Do you have any experience counseling individuals with substance abuse problems? Yes No

* Have you attended AA or NA meetings? If so, in what capacity and for how long? Yes No

* Have you received treatment for a mental illness or condition? Yes No

* If so, how long ago? Are you still receiving treatment? Yes No

* Do you have any counseling experience? Yes No If so, did you work with youth or with adults?

5. Criminal Justice System Involvement:

IF the mentor's application reveals prior convictions, incarcerations, and/or period of supervision, ask the following:

* Given your experience with the criminal justice system, what would you say is your attitude toward community supervision?


* Did you complete your period of supervision successfully? Yes No

* What was your biggest challenge in doing so?


* How, if at all, would you say community supervision influenced your attitudes toward the crime and justice?


IF no direct experience, begin here:

* Have any family or friends had significant contact with the criminal justice system? Yes No

* How did the experience change your feelings about crime and justice?


* Have you, or any family or close friends, ever been the victim of a crime? Yes No

* How did you feel about the experience^?


* How did it change your attitudes toward crime and justice?


Have you worked with offenders in a prison or community corrections setting? Yes No

If so, how?