Home > Mentor Log

1. Mentor name:

2. Mentor Email:

3. Mentee name:

4. Activity Date (year-month-day ex: 2018-05-16):

5. Start Time:

6. End Time:

7. Location: (Use Ctrl-Click to choose multiple locations)

8. If your selection has an asterisk(*), please input the specific site (for example, which school or trail):

9. If you did NOT meet at an approved site, did you have written permission from your mentee’s parent AND permission from the program director?
 Yes No

10. Please record notes and a brief description of activity (including a summary of your meeting, relevant behavioral observations, details about who else was present, or plans for the future):

 

This online mentor form is made possible by the generous contributions of WabiSabi and AWebStudio.