Weekend Miracles Mentor
Report |
Please complete form weekly or after
each meeting with your Weekend Miracles mentee. |
Your (Mentor) Name: |
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Your E-mail: |
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Weekend Miracles Child Name: |
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| About
the Child: |
1.
Please list dates you got together with 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. |
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2.
How did the mentee respond to the activity(ies)? What does the child like
to do? |
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3. Did you
have phone or email contact with your mentee between visits? If so, please
describe. |
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4. Have you learned anything
new about your mentee? If so, please describe. |
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5. Describe how the mentee's personality
has emerged. |
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6. Describe how you and the mentee
are adjusting to each other. |
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7. How does the mentee relate to other
adults? Is the child respectful, comfortable, cooperative, and accepting
of adult authority? |
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8. Please describe your perception
of the emotional state of the child. Does the child seem sad, happy, etc.? |
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9. What do you like about the child? |
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| 10. Have you had any problems
and/or do you have any concerns about the child? |
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| 11. Is there information that could have
helped you manage these problems? Would you like to discuss these concerns? |
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| Best Time of Day to Reach You? |
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| 12. Date of Next Planned Meeting? |
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| A
copy of this completed report will be sent to Kidsave. You
will also receive a confirmation copy by return E-mail for your records. |
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(Click submit to send.) |
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