Mentor Monthly Event Program Report
 For Mentors: Use this form after program event
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Your name? *
Name and location of event. *
Date of event *
MM
/
DD
/
YYYY
Your Student's name *
How did the student arrive at and leave the event? (transportation) *
What was the mood of your student at the start of the event? *
What was the mood of your student at the end of the event? *
What role did the student assume? *
How was the relationship between you and the student? *
Good
bad
Give your brief overall description of your time with the student.  Include the entire time that day with the student. *
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