Mentor Monthly Report


Due by the first (1st) of the month for previous 15th through 15th period.)

Mentor Information:

Case Manager:

Mentor Full Name:
Phone Number:
Email:
Street Address:
City, State, Zip:
Cadet Name:
Phone Number:
Email:
Street Address:
City, State, Zip:

Type of Contact:

Did you have at least 4 hours of contact with your Cadet? Yes No

Date Specify Type (i.e. Email, Face-to-Face)

Post Residential Placement Activity:

Please check all boxes that best describes what your Cadet has been doing during the reporting month.Please write the dates that he/she enrolled in school, enlisted in a military service/shipped, or began working including employer’s name and wage amount.

Education Military Service Miscellaneous
Return to HS Active Reserve
Care Giver
Vo Tech Army
Homemaker
College Navy
Incarcerated
Job Corps Marines
Disabled/Hospitalized
Adult Education Air Force
Moved Out-of-State
Coast Guard
Deceased
National Guard
Arrest/Violations
Enroll Date: Enlist Date:
Unknown
School: Ship Date:
Counselor: MOS:

Employment/Volunteer:

Hire Date Company Position Wage
Part Time
Full Time
Supervisor Name and Phone:
Termination Date:

Reason:

Additional Information:

If your Cadet has made changes to his or her P-RAP (Post-Residential Action Plan), please provide the following information: Specific changes to the P-RAP; The Cadet’s expected outcome as a result of the changes; Why the Cadet made the changes; The mentor’s position and rationale regarding the changes?