PSC Mentor Reporting Form
This form is to be completed by a PSC mentor each time you complete a mentoring activity. We will use this form to compensate you. We appreciate your help!
Email address *
Your Name (First and Last) *
Your answer
Report Date
MM
/
DD
/
YYYY
Describe the mentor activity or activities that you conducted. These can include but are not limited to: contributing to social media discussions (facebook, twitter, website forum, youtube), visits to teachers/students ( teacher meetings, classrooms, virtual via skype), video editing, software, monthly mentor meeting.
Your answer
How much time did you spend on these activities?
Your answer
If you interacted with students, how many 8th-12th grade students did you reach?
Your answer
The students appeared to be engaged during my visit
Strongly Disagree
Strongly Agree
If you were inactive during this reporting period, can you provide some details about the obstacles that prevented you from working?
Your answer
Comments for PSC staff?
Your answer
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