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* 1. Mentor Name

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* 2. Mentee Name

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* 3. Month reporting info for

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* 4. How many times did you spend, in-person, with your mentee this month? Please include dates that you met, for how long, and what you did.

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* 5. How many hours did you spend in contact with your mentee through phone calls, text messages, or emails this month?

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* 6. What activities did you and your mentee do together this month?

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* 7. What Goal Planning Exercise, or goal-related activity(ies) did you and your mentee complete this month?
Please include date and the exercise completed.
(Refer to Educate Tomorrow Mentor Curriculum Guide)

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* 8. Please give us an update as to the status of your relationship.

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* 9. Are there any issues that you and or your mentee are experiencing that ET can assist you with?

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* 10. What are your plans for next month, in regards to your mentee?

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* 11. Mentee Status Information:

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* 12. Feedback/ Requests for ET Staff

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