MW 111- 3 I Mentor Interview I 1. Why are you interested in becoming a Mentor?* haw}: K\d? Onol mo (Pig ICthhood Family 2. Where were you born? 9 (3y; Homo/e; . 3. Who raised you?* (11ml) ch. 55qu 4. What was your relationship like with your parents? Norma.) 5. Did you have brothers or sisters? g??gq ?3234: Paju? (?3Ule at 55:, 6. What was your relationship like with your brothers and sisters? gamma (3. ?512;; emu: mum Wang, m; raga rid-Sipa mos .. Olhg?i- 53er gauge \wrm Liam cap 512:. . Mentor Interview Privileged and Con?dential Activities 7. What did your family do for fun? Camgk?g Ln Cit 01}. Wet? 8. What was?a typical weekend like in yourfamily? amen xvi maifm't (36156015.. (Mer malt-st; 9. What did you like to do for fun? gutter: shame/mart} Discipline 10. Tell me about a time when you got in trouble. What happened?" Ls}? enhance. lei-car} {Kim mesa?Gk! ?96130.. can nG-rgw?wg sum pthri?t. 11 . What were the primary methods of discipline used in your family?* are (mm 12. Who was the primary disciplinarian in your family? mien/i 13. What do you think about how your parents handled discipline problems?* 13ml GM . ("Dr 1. gr mom ?ire-rs ?ii?fawn? 14. When there were disagreements between you and your parents, how werethey resolyed? did) (3-de Mentor Interview Privileged and Con?dential [Adolescence Family 15. How did you gm along your during your mn years? 18. When you did something Wrong, what did your parents do?' Hp Amman/1 W331 r924. Uwod 17. How did you get along with yuur brothers and sislers during your um years? 13. What role d1d rcligion play in your family?" Mafia. 19. What. was your family's attitude towaxd sexuality? Was it discussed? Was it considund sinful? Normal'l' Interactions with Others 20. Tell me about your social life during your teen ycars. What did you do far fun'I' Mentor Interview Privileged and Confidentiai 111-6 21 . Who were ion: best fricnds in schoo'?' 22. How did you do academically'? rp/'Pc'f Wihag} General 23. Tell me about your fundest memory muryom childhood or you were a wen. fig 01 M7 WA a mi", 24. Tall me about ynur mos: significant inss when you were a child or a (can, (< Nd Menlcr Interview Privileged and Confidential 7 27. Tell me about your work history.* mom?? its?metres my race -\Cl Cab) Carthage MC gi?mXP-J CA?Qg?m?fhf?u?ksp Wynne-?it Ah (?r?i-if?b 0&9? 28. What is your current position? Pix-2 {Swot-cm 1 manl- fawning. entermm'uea? Omar. EH33: quJCunf?b amm?frn 1 i 29. Where did you work before this? Why did you leave your last position?* ave ou _Lg.c4? rm byes only?de r5 10d (IQ-APT rnr- . n. 31 . What type of discharge did you receive?* e? 32. Tell me about a time when you felt really successful in school or work.* 4AM 33. Tell me about a time when you were really disappointed in your school or world" Gem-F (?in?rm @n?Qf SR J. . 73mm WE. Cleft-m 41?) 90+ P91:lein .. ?3 Mentor lnterv'iew Privileged and Con?dential Activities and Snclal Life 34. How do you spend your free time?" 35. Wet are your hobbies? How much time do you on ihese?' mu 36. How oflcn do you spend time with friends?' An vh. ruLyfiamuH- 31. What are your favorite activities to do with friends?' < A A AWehfi) - Mentor Interview Privileged and Confidential 9 41. 42. 43. 44. 45. 46. 47. What do you see as the most signi?cant limitation in the relationship?* Dem 3+ 9 Have you ever sought help ?'om a marriage counselor? For what reason?* '1 re- L) What are your attitudes about sexuality?* Esteem. . How many times have you been married?? Tell me about your ?rst marriage.* How old were you when you were ?rst manied?? [1/1 Why did you decide to get married? Mentor Interview Privileged and Con?dential 9 - 10 48. Why did the marriage end? ii?? 49. Did you have children from that marriage? How often do you see them?* (Repeat questions 4 7 through 49 for each marriage) Abuse History 50. When you were a child or teenager were you ever emotionally, physically, or sexually abused?* 51. In any of your signi?cant relationships, have the police ever been called because of domestic violence?* MD 52. Have you ever been abused by your spouse or a signi?cant other?* No 53. Have you ever lost your temper and shoved or hit your spouse or signi?cant other?? \i?s \Je?ci (Pb-(Vii Hid-?i Mentor Interview Privileged and Con?dential 9 111-11 54. Have you aver panicipalcd in any child abusc, spouse abuse, or domestic Violence?' ND Children and'Famuy Life 55. Tell me about :ach ofyour childrm, -- 59. What are your childrm's best quammv In: 51. What have bean the most serious difficulties you'v: had lo face will-l each of your children? To. . O, 58. How did you handle lhcm'! Imammw: Q: - adufi :2 - city; 92: 3m: 55. How do you relate to your childrc-n'l stepchildren?' 3mm elkvr aden so. How does your Spouse relate to your childm-l? stepchildren?' Rm, .2 aux": oxng Mentor Interview Privileged and Confldenlial 12 61 . How do your children get along with each other? Janitor lqu? 62. How do you handle con?icts between the children? l?l'q? Health and Mental Health 63. Being a Mentor is likely to place some physical demands on you. Do you have any concerns about being able to meet the physical requirements of the ND 64. Do any members of your family have health problems?* MC) 65. Is anyone in your household on medications? For what reason?* Mt?) 66. How do you manage stress in your life?* [Amen (155 can fits-thrm?. Like new. be, late/l? aftm . Genny 67. How do you think that being a Mentor will affect the stress in your family?? . (0 Ohm} On :MQQAaon?lf": . U3m?4~ un?- ?53" I Mentor Interview Privileged and Confidential 68. 69. 70. 71. 72. 13 What is your plan for managing the added stress if you do become a Mentor?* Are you or is anyone in your household seeing a or therapist for mental health issues?* NO Have you, or has anyone in your household, been hospitalized for mental health problems?* W0 Do you or any member of your family use illegal drugs?" MD How often do you and other members of your household consume alcohol?? . ?31?.le LU SCQQUUQ. Extended Family 73. Who is in your extended family?? c3? rm Amman?: ?3 ?tbii?C??; . 74. H_ow would you describe your relationships with your extended family?* ahmrf dips: elm-r3 -- glean a. omens, ddz??t?? mar ?Gaewlls?n Mentor Interview Privileged and Con?dential Ill-14 75. How eflcn do you get mgethcr with them?' go. an > 13. Tell m: about your work history.' 19. What xs your position? imam--m 20. Where did you work before am Why did you leave your last posm'on?" 21. Have you scrved the military? For how long'!' NI) Infierview with other Adults In the Home Privileged and Confidentia' - 72 22. What type of discharge did you receive?* Alti?? (U 23. Tell me about a time when you felt really successful in school or work.* 24. Tell me about a time when you were really disappointed in your school or work.* . 594 pres - 4., ?Me.Iir. When . Activities and Social Life. 25. How do you spend your free time?* Gal Oran ?nry .1662}; Madrid; mnril lag ?1 IN 26. What are your hobbies? How much time do you spend on these?* 27. How often do you spend time with friends?* 28. What are your favorite activities to do with friends?? Interview with other Adults in the Home Privileged and Con?dential 73 Marital 29. 30. 3?1. 32. 33. 34. 35. Tell me about your current relationship with your spouse or signi?cant other. How long have you been married?* or cam} qmrs. bum-1 her an mx! has. ma?a cl. What do you see as the greatest strength in your relationship with your spouseor signi?cant other?* 55%:ch ?1 rant? What do you see as the most signi?cant limitation in the relationship?* Sims wabaes . Have you ever sought help from a marriage counselor? For what reason?* NO What are your attitudes about sexuality?* W?mc??hf How many times have you been married?* C) Did you have children from that marriage? How often do you see them?* Interview with other Adults in the Home Privileged and Con?dential 9 - 74 (Repeat question 35 for each marriage) Abuse History 36. 37. 38. 39. 40. When you were a child or teenager were you ever emotionally, physically, or sexually abused?* Mo In any of your marital relationships, have the police ever been called because of domestic violence?* gr) Have you ever been abused by your spouse?* MD Have you ever lost your temper and shoved or hit your spouse?* ?bamv/jl hol? Have you ever participated in any counseling related to child abuse, spouse abuse, or domestic violence?* MD Interview with other Adults in the Home Privileged and Con?dential - 75 Children and Family Life 41. Tell m: about Each ul'your cl'nldren. 42. How do you relat: to your 43. How does your spouse rclate to your children? stepchildren?" garing :31 5g 5? \elfisp :am'm 44. How do your gut along wim each mher? ulfi 45. How do you handle conflicts between an children? Health and Mental Health 46' An: you or is anyune in your houschold seemg a or therapist for mcntal hcalth Issues?'K <