Date		Type of Contact	Length of Contact	Activity/Comments
		Select a response... One-to-One In Person One-to-One In Group Phone or E-mail or Letter	Select a response... Less than 1 hour 1 to 2 hours 2 to 3 hours About half a day Entire day
		Select a response... One-to-One In Person One-to-One In Group Phone or E-mail or Letter	Select a response... Less than 1 hour 1 to 2 hours 2 to 3 hours About half a day Entire day
		Select a response... One-to-One In Person One-to-One In Group Phone or E-mail or Letter	Select a response... Less than 1 hour 1 to 2 hours 2 to 3 hours About half a day Entire day
		Select a response... One-to-One In Person One-to-One In Group Phone or E-mail or Letter	Select a response... Less than 1 hour 1 to 2 hours 2 to 3 hours About half a day Entire day
		Select a response... One-to-One In Person One-to-One In Group Phone or E-mail or Letter	Select a response... Less than 1 hour 1 to 2 hours 2 to 3 hours About half a day Entire day

How would you say that things are going so far?

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What would you say was your biggest accomplishment  working with your mentee this past month?  (i.e., improvements in school, attitude, self-esteem, communication skills, confidence, etc.)

What things do you think remain as obstacles?

Please use the space below to tell us about any other concerns or to share your suggestions or ideas.

Would you like VIP to contact you?

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