Mentor Monthly Report

The monthly Mentor Report is due by the 15th day of the month, reporting for the previous 15th through 15th period.

For questions, contact Mentor Coordinator, Dan Drover, at (208) 464-1467.

* Indicates required field

    Cadet Name:*

    Mentor Name:*

    Email:*

    Did you have at least four (4) hours of contact with your Cadet this past month?:*
    YesNo

    Contact Date 1:

    Contact Type 1:

    Contact Date 2:

    Contact Type 2:

    Contact Date 3:

    Contact Type 3:

    Contact Date 4:

    Contact Type 4:

    Contact Date 5:

    Contact Type 5:

    Additional Information:*

    Please check all boxes that best describes what your Cadet has been doing during the reporting month. Please enter the dates that he/she enrolled in school, enlisted in a military service/shipped, or began working. Also, include a school/work/recruiter phone number, so we may verify.

    Attending School:* YesNo

    Working?:* YesNo

    In the Military?:* YesNo

    Doing something else?:* YesNo

    What is the starting date for your Cadet's Placement activity, which you specified above?:

    By submitting this form, I agree with Idaho Youth ChalleNGe Academy's Privacy Policy*.

    I consent to having Idaho Youth ChalleNGe Academy collect my name and contact information, in order to properly process my form submission. Idaho Youth ChalleNGe Academy will never sell your information, and you are welcome to opt-out of our mailing list at any time.
    YesNo

    If your computer’s browser is reporting an error when trying to submit this report, please try another browser or wait and attempt to resubmit later. Otherwise, you may either 1) complete and return this PDF form, or 2) send an email with your monthly report details to the Mentor Coordinator at [email protected].