Graduate's Month Assessment

Today's Date * +

Month of Report *

Graduate's Class Number *

Team Number *

Graduate's Name *

Graduate's Phone Number *

Graduate's Address *

Mentor's Name *

Mentor's Phone Number *

Mentor's Address *

No Contact with Cadet- Select "Unknown" in the fields below in the 4 required areas to be able to submit your report.

No Contact with Cadet

Mentor/Mentee Contacts

Date of Contact +

Type of Contact

Comments

Date of Contact +

Type of Contact

Comments

Date of Contact +

Type of Contact

Comments

Date of Contact +

Type of Contact

Comments

Graduate's Employment Status

Graduate's Employment *

Place of Business:

Supervisor's Name:

Supervisor's Phone Number:

Weekly Hours

Starting Date +

Pay Rate

Job Title

Notes:

Graduate's School Information

Graduate's Status *

School Name:

Contact Name and Number:

Graduate's Enrollment Status

Starting Date +

Program of Study:

Graduate's Military Information

Graduate's Military Status *

Military Service Componet

Enlistment Date +

Notes:

Graduate's Volunteer Information

Graduate's Volunteer Status *

Organization or Agency:

Supervisor's Name

Supervisor's Phone Number

Weekly Hours Volunteering

Starting Date: +

Job Title

Notes:

Map Review Remarks

Map Change Status *

If YES, Indicate MAP changes here:

What is the mentee's expected outcome as a result of these changes:

Why did the mentee make these changes:

What is your position and rationale regarding these changes:

Staff Contact-If you think your mentee could benefit from a contact from our staff this month (for a word of encouragement or to light a fire!), Please indicate this in the Remark's section below.

Comments: Include Mentor's or Mentee's change of address or telephone number, good news, concerns, etc.

Email this report to: *