Mentor Activity Report 2017-2018

Thank you!

Issues of confidential nature should not be addressed on this form. Contact Jennifer Silliman at 561-843-6964

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* 1. Please complete the following:

Your First Name:

Your Mentee's First Name

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* 2. Month Activity Took Place:

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* 3. Monthly Activity

# of In-Person Meetings

# of Phone Calls

# of Text Messages

# of Emails

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* 4. Please provide the dates you met with your mentee in-person.
If you met OUTSIDE of school campus please list the location where you did meet!
If you weren't able to meet in-person, please explain in detail why.

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* 5. Please explain in detail your progress with the 2017-2018 Curriculum Activities. What projects are you working on, what was completed, etc. The program coordinator will follow-up on your progress.

Example: Sarah and I have talked about her graduation requirements and are working on locating places where she can complete the 20 volunteer hours she needs to graduate. We've both agreed to come up with a list and share them at our next in-person meeting.

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* 6. Please describe in detail any activities/discussions (other than the Curriculum Activities) you and your mentee have been involved with this month. This can include; school projects, college prep activities, family planning, tutoring or employment preparation.

Example: Sarah and I talked a lot about family planning this month. She wants to start taking contraception so we took a look in her binder and found the phone number for the Delray Beach Health Department. She's going to make an appointment and find someone to take her there. I will follow up with her weekly to make sure she makes and goes to her appointment.

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* 7. Describe any major obstacles that have come up in the relationship. Explain how they were handled. Answer is required so if there are no obstacles please type "NO OBSTACLES".

Example: Sarah takes a while to respond to my text messages so it's hard to get a confirmation on our meeting dates. To handle this obstacle I'm going to talk to her about the importance of getting back to me more quickly and from now on we'll set our next date together while we're meeting.

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* 8. Please check the box that best describes your mentee's motivation in the following areas this month:

	Increased	No Change	Decreased	Don't Know or N/A
Grades/School Performance	Grades/School Performance Increased	Grades/School Performance No Change	Grades/School Performance Decreased	Grades/School Performance Don't Know or N/A
School Attendance	School Attendance Increased	School Attendance No Change	School Attendance Decreased	School Attendance Don't Know or N/A
Time Management Skills	Time Management Skills Increased	Time Management Skills No Change	Time Management Skills Decreased	Time Management Skills Don't Know or N/A
General Attitude & Outlook	General Attitude & Outlook Increased	General Attitude & Outlook No Change	General Attitude & Outlook Decreased	General Attitude & Outlook Don't Know or N/A
Self-Esteem & Confidence	Self-Esteem & Confidence Increased	Self-Esteem & Confidence No Change	Self-Esteem & Confidence Decreased	Self-Esteem & Confidence Don't Know or N/A
Communication with Mentor	Communication with Mentor Increased	Communication with Mentor No Change	Communication with Mentor Decreased	Communication with Mentor Don't Know or N/A

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* 9. Please provide any additional comments, suggestions or questions you have for the program coordinator.
How is school going for your mentee? How do you think your relationship is developing? Do you have any suggestions for program improvement?