Natural Helpers Report Form
Please complete this form each time you have a situation where you work through a problem or situation with a friend, classmate, or relative.
Name of Natural Helper *
Name of person receiving help *
Type "anonymous" if this person wishes to remain anonymous
Describe this helpful encounter *
Have you referred this situation to an adult? *
What is the name of the adult referred? *
How much do you feel you helped this person with this specific situation? *
Does this interaction encourage you to continue to help people? *
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