MENTOR MONTHLY REPORT

    Thank you for completing your monthly report.  By providing documentation on the number of hours you spend with your mentee and the types of activities you do together, you are helping maintain the funding for BRIGHT Families.  We appreciate all of your hard work, dedication and commitment to the BRIGHT Families Project!  

 

MENTOR NAME
MENTOR E-MAIL
   
MENTEE NAME

COORDINATOR NAME                 

THIS REPORT IS FOR THE MONTH OF: (Please specify month & year)

TODAY'S DATE:

 

OUR ACTIVITIES THIS MONTH:

Contact  Date

Location  

 Activity        

 Time  Spent         Mileage

 

REPRODUCTIVE HEALTH COVERED THIS MONTH:
Clinic Tour   (2.0 Hours)  Date:
Health Workshop (6.0 Hours) Date:
Other  Date:

Any comments regarding reproductive health topics covered:

 

GOAL SETTING COMPLETED THIS MONTH:
Family Planning Goal Plan
Financial Support Goal Plan
Positive Relationships Goal Plan
Parenting Goal Plan
Giving Back to My Family Goal Plan
Other Goal Plan

 

Was Support Tree completed this month?     Yes No         How many supports were identified?

Was a Lifetime Mentor selected this month?    Yes No

            Name of Lifetime Mentor: 

            Lifetime Mentor's relationship to mentee:

Date of the support group or individual supervision that you attended this month: 

Please list any successes, problems, concerns or comments here: