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

Match Participants

Name of Mentor (first and last):(Required)
Name of Mentee (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 mentee; 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 mentor about each of the Six Conditions but case-note only what's not working, is not meeting expectations, needs follow-up or is exceptional!
What activities have you done recently with your mentee? What are your favourite activities? What activities have you proposed or engaged in that support your Mentee’s development and growth? (e.g. they love science, and you suggest doing a science experiment)
1A. Activity Expectations
Have you had any challenges following through on consistent Match visits? If yes, why? Have you had any challenges in your Match?
2A. Consistency Expectations
Describe the connection/relationship you have with your Mentee. Would your Mentee talk to you if something was bothering them?
3A. Connectedness and Closeness Expectations
What are some of the changes have you noticed in your mentee since you first met and what do you see as their strengths? What have you learned from your Mentee? Give me an example of a success or an accomplishment in your match. What are you most proud of in your match?
4A. Youth Centeredness Expectations
Have you had any contact with your Mentee outside of school (in person, email, social media, phone, text, etc.)? If so, please elaborate. Was the support you received from agency/school helpful and sufficient? Is there any support you need for the remainder of the year? How can we make the Mentoring program better for next year?
5A. Structure Expectations
Finish this sentence: Having a Mentee was . . . " " Are your expectations being met? How or how not? What do you find fulfilling about this experience?
6A. Duration Expectations

ISM Specific Questions

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