State of Illinois
Department of Human Services

Dear Disability Mentoring Day Participant:

We are sending this evaluation form to find out your opinion of your Disability Mentoring Day experience.

Here are a few questions that we would like you to answer. Feel free to be completely honest with your answers. This questionnaire will assist us to make future Disability Mentoring Days as successful as possible.

1. I participated in Disability Mentoring Day on ___________ (date).

2. I was a: __________ Mentor (Employer) __________ Mentee (Student/DRS Customer)

3. How would you rate your experience of Disability Mentoring Day?

 a. ______ Great!

 b. ______ Good!

 c. ______ Average.

 d. ______ Not worth it.

 e. ______ A very bad experience.

4. Could this be a good employment match?

5. Would you participate in Disability Mentoring Day next year? Yes _____ No _____

6. What do you think would improve the experience of Disability Mentoring Day?

7. Other comments:

First Name: ____________________________________ Last Name:______________________________________

Company Name: ____________________________________________________________________________________

Address: ____________________________________________________________________________________________

City: _________________________________________________ State: ________ Zip Code: ___________________

Telephone Number: ____________________________ Email Address: ____________________________________

Please complete within 2 weeks of event and fax to 630-892-7461 OR return via mail to:

DHS/DRS - ERS
888 S Edgelawn Ave Suite 1771
Aurora, Illinois 60506