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Weekend Miracles Mentor Report

Please complete this form after each meeting with your Weekend Miracles Mentee.

*Last Name:

*First Name:

*Your E-mail:

*Weekend Miracles Child Name:

About the Child:

1. Please list dates you got together with your mentee since your last report. For each date, include when and where you met or picked up mentee, what you did, and how long you were together.

2. How did the mentee respond to the activity(ies)? What does the child like to do?

3. Did you have phone or email contact with your mentee between visits? If so, please describe.

4. Have you learned anything new about your mentee? If so, please describe?

5. Describe how the mentee's personality has emerged.

6. Describe how you and the mentee are adjusting to each other.

7. How does the mentee relate to other adults? Is the child respectful, comfortable, cooperative, and accepting of adult authority?

8. Please describe your perception of the emotional state of the child. Does the child seem sad, happy, etc.?

9. What do you like about the child?

10. Have you had any problems and/or do you have any concerns about the child?

11. Is there information that could have helped you manage these problems? Would you like to discuss these concerns?

What is the best time of day to reach you?

12. Date of next planned meeting?

A copy of this completed form will be sent to Kidsave.
You will also receive a confirmation copy by return email for our records.