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PIE FALL 2009-SPRING 2010 STUDENT QUESTIONNAIRE

Greetings Students!  Below is a brief questionnaire which intends to gather information regarding your interests and motivations along with various personal characteristics and interests.  The information will be used to make the best match possible for this year's Partners In Empowerment Program.  All information will be kept confidential.

Please call (716.883.3331 ext. 318) or e-mail (ryan@compeerbuffalo.org) Ryan with any questions or concerns.  Please submit the survey no later than Friday, September 18th by 5pm.  Have a great day!
First Name
Last Name
Mailing Address
Phone Number You Are Best Reached() -
E-mail Address
What do you know about mental illness? Do you have any experience, either work related or personal with mental illness? Please explain in detail.
What do you feel are some of the major challenges faced by individuals living with mental illness?
How do you feel about people diagnosed with mental illness?
Please name four personal strengths that will best serve you in this Compeer relationship.
What are your expectations for this relationship?
How do you plan on seeing/getting togther with your Compeer partner for the next two semesters? What blocks of time are you available to meet? What means of transportation do you have?
Are you currently employed? If yes, where? What are your current job responsibilities?
Where are you placed for your internship?
What are some of your hobbies and interests? Who do you typically do these things with?
What part of this program are you looking forward to the most?
Comments or Concerns

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Compeer of Greater Buffalo   135 Delaware Avenue, Suite 210    Buffalo, New York 14202    716.883.3331    Fax: 716.883.3395