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) *
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.
How much time did you spend on these activities?
If you interacted with students, how many 8th-12th grade students did you reach?
The students appeared to be engaged during my visit
Strongly Disagree
Strongly Agree
Clear selection
If you were inactive during this reporting period, can you provide some details about the obstacles that prevented you from working?
Comments for PSC staff?
Submit
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