Mentor Monthly Report Form
We would love to hear about you and your mentee! It is important for us to know what the youth is up to or if there are any specific needs or challenges we can help families and matches work through. We also love to celebrate the achievements that have been made! This information helps us support your matches' goals, while also providing data that is utilized in grant applications to continue financial support of our program. We thank you in advance for your time submitting this report.
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Email *
Month: *
Mentor Name: *
Mentee Name: *
How many times have you seen your youth this month?  *
How many hours did you spend together?  *
List events/activities you have done with your youth:  *
How does the youth respond to your get togethers?  *
Is the youth having any apparent problems with family, school, or friends? (If yes, please provide details.) *
Does the parent show interest and cooperation? (Please provide details) *
Do you need help communicating with your youth or their parent(s)? (Please provide details) *
What have the successes been for this month? (Please provide details) *
What are some of the concerns or challenges in your match and/or with your youth (social, emotional, educational, or health)? *
What goals can you identify to work on with your youth? and/or What goals does your youth identify needing help with?  *
Would you like us to call you?  *
Share with us a "Mission Moment" - rewarding experiences related 1) your match relationship, 2) school work/attendance, 3) connections with friends/other youth, 4) respect for others/manners, 5) responsibility at home/school/behaviors, 6) improvement of self-esteem, 7) other, please explain:  *
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