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 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 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 been doing together each week? What were some of the highlights? What did you enjoy most about your time together?
1A. Activity Expectations
Were you both able to see each other every week? Probe: Are you happy with how often you’ve seen your mentee?
2A. Consistency Expectations
What did you like about each other?
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?
4A. Youth Cenredness Expectations
How can we make the Mentoring program better for next year?
5A. Structure Expectations
Finish this sentence: Having a Mentee was . . .
6A. Duration Expectations

Big Three survey

BIG SOCIAL: Because of their time in the program, my mentee is better at treating others with respect.
BIG WELL-BEINGBecause of their time in the program, my mentee is better at handling challenges.
BIG POSSIBILITIES: Because of their time in the program, my mentee is better at trying new things and learning.

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 mentee".
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?