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Name (email) of Staff Member completing check-in:(Required)
Method of answering check-in questions:
Program Site

Match Participants

Name of Mentee (first and last):(Required)
Name of Mentor (first and last):(Required)

Six Conditions

Make sure to include preparation for match closure. Consider the following: 1. Confirm that all matches wrap-up at the end of the school year; 2. Discuss what they may say to their mentor; 3. Talk about how they would like to celebrate their match; and 4. How are they feeling about saying goodbye and recognizing those natural feelings? REMEMBER: check-in with the mentee about each of the Six Conditions but case-note only what's not working, not meeting expectations, needs follow-up or is exceptional!
What has been your favorite activity to do with your mentor since the last time we checked-in? Probe: What is your favourite memory with your mentor?
1A. Activity Expectations
Did you visit with your mentor every week? Probe: Are you happy with how often you’ve seen your mentor?
2A. Consistency Expectations
Do you always feel safe and comfortable with your Mentor? Probe: On a scale of 1-10 how safe and comfortable do you feel with your mentor? Has your mentor done anything or asked you to do anything to make you feel unsafe or uncomfortable? Has your mentor asked you to keep a secret? If yes, please explain.
3A. Connectedness and Closeness Expectations
What does your mentor do to make you feel important or special? What have you learnt from your mentor?
4A. Youth Cenredness Expectations
Have you had any contact with your Mentor outside of school? Please elaborate. How will you show your mentor that you have enjoyed the time together and that they are appreciated?
5A. Structure Expectations
Finish this sentence: “Having a mentor makes me feel...” Probe: Describe how having a mentor makes you feel. What do you like about having a Mentor?
6A. Duration Expectations

ISM Survey Questions

Having a mentor made me feel happier at school:
I talked with my mentor about with my problems:
Would you like to be involved in the program again for the next school year?
Do you want to have the same mentor again for the next school year?
If the mentee does not want to be matched with the same mentor next year, please provide details in box labelled "Additional information from mentee".
Is there anything you want to talk about or do you have any concerns?
If the mentee has concerns, please provide details in box labelled "Additional information from mentee".
Conclusion(Required)
This field is for validation purposes and should be left unchanged.