Parent POE

Date Completed
Child's Name
Child's Age
Child's Gender
Child's Program
Child's Ethnicity
Volunteer's Name
Match ID
Length of match (as of today)	(specify in years)

We would like you to describe any changes you have observed in the below areas over the past year. It’s okay to indicate “don’t know” if you have no knowledge about change in a given area.

	Much Better	A Little Better	No Change	A Little Worse	Much Worse	Don't Know	Not A Problem
CONFIDENCE
1) Self-confidence
2) Able to express feelings
3) Can make decisions
4) Has interests or hobbies
5) Personal hygiene, appearance
6) Sense of the future
COMPETENCE	Much Better	A Little Better	No Change	A Little Worse	Much Worse	Don't Know	Not A Problem
7) Uses community resources
8) Uses school resources
9) Academic performance
10) Attitude toward school
11) School preparedness (homework)
12) Class participation
13) Classroom behavior
14) Able to avoid delinquency
15) Able to avoid substance abuse
16) Able to avoid early parenting
CARING	Much Better	A Little Better	No Change	A Little Worse	Much Worse	Don't Know	Not A Problem
17) Shows trust toward you
18) Respects other cultures
19) Relationship with family
20) Relationship with peers
21) Relationship with other adults
Is there any additional comments you would like to make?