Daily Progress Report

Each day after you are with your student please fill out this form. Thank you.

Mentor's Name

*

Student's Name

*

Teacher's Name

Date

*

Objectives for the Day:

*

Please select all that apply.

Social/Emotional Academic Character Other

Highlights of how we spent our time together:

Relationship Building

*

Character or academic activities

*

Creative Play

*

How did your Student respond with attitude and cooperation? Scale of 1 (needs improvement) to 5 (outstanding).

Attitude

*

Please select one option.

1 2 3 4 5

Cooperation

*

Please select one option.

1 2 3 4 5

Personal Reflextion

How did you feel after the Session? Scale of 1 (needs improvement) to 5 (outstanding).

*

Please select one option.

1 2 3 4 5

Memories from our time together today?

*

Questions or concerns for the teacher or director:

Please specify here

*

If this is an issue that needs immediate attention, contact the director or talk to the principal before leaving the school.

Description

Each day after you are with your student please fill out this form. Thank you.

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