Monthly Mentor Activity Log

CSOSA Faith Based Reintegration Services
Monthly Mentor Activity Report Log
(Return to Forms and Applications)

Date:

Mentee Name:

Mentor Name:

Mentor Phone #:

Mentor Email Address:

1. How many times have you been in contact with the mentee?
Number of Contact in Person:
Number of Contact Over the Phone:

2. Approximately how much time in total did you spend this month in person with the mentee?
Hours Minutes:

3. Approximately how much time in total did you spend this month on the phone with the mentee?
Hours Minutes:

4. What would you say were his or her needs this month?


5. How did you help your mentee to meet those needs this month?


6. Overall, how would you rate the quality of your relationship with your mentee?
Poor Fair Good Very Good Excellent

7. Overall, how would you rate the progress of this mentee?
Poor Fair Good Very Good Excellent

8. Please share any other comments you have about your mentoring relationship in going with this mentee.


9. Did the mentoring relationship end this month? Yes No

If yes, please provide the date or estimated date that the relationship began and ended. Please also describe the factors that contributed to the end of the relationship.


Thank you for participating in this monthly survey of mentor's in the CSOSA Faith Based Reentry Initiative.

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