Home > Mentor Log

    1. Mentor name:

    2. Mentor Email:

    3. Mentee name:

    4. Activity Date (month/day/year ex: 05/16/2018):

    5. Start Time:

    6. End Time:

    7. Location: (Use Ctrl-Click to choose multiple locations)

    8. If your selection has an asterisk(*), please input the specific site (for example, which school or trail):

    9. If you did NOT meet at an approved site, did you have written permission from your mentee’s parent AND permission from the program director?

    10. Please record notes and a brief description of activity (including a summary of your meeting, relevant behavioral observations, details about who else was present, or plans for the future):


    This online mentor form is made possible by the generous contributions of WabiSabi and AWebStudio.