Mentor After Visit Check-in Form
Hello Mentors! Please take a few minutes to share about your most recent visit with your mentee and answer a few questions about how the program is going for you and your match. 

Please note that program staff does take the time to reach each one of your responses and it is helpful to have as much detail as possible about how your outings are going.
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Your Name *
Mentee's Name *
Date of Meet Up *
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Please share about what you did with your mentee during this visit. Please provide details like pick up/drop off times, what you did, etc. (example: I picked up Jack at 4pm, and we went swimming at the Fidalgo Pool during their open swim. We had a lot of fun playing diving games, and I taught them how to do the back stroke. We went for hot chocolate afterwards, and then I dropped them off at home at 6pm.) *
Is there anything that you feel would be important to share about this last visit? Please be specific. *
Would you like a follow up call? *
How long did your visit last? *
Required
When is your next planned visit? *
When communicating with their parent/guardian, who usually initiates contact? *
How is your mentee's behavior when you are together? Have there been any recent changes in behavior? Please be specific when describing behaviors that you are experiencing. *
Is there anything going on with your mentee's family that would be good to share with our Program? Changes to family structure, school problems, conflicts with peers, etc. *
How does your mentee respond when trying new activities? *
What good things are happening with your mentee? This can be things that they have shared with you, or things that you both are experiencing in your mentoring relationship. *
How are you feeling about your mentoring relationship? *
Are there any concerns that have come up about your mentoring relationship that you would like share? *
Optional: What training topics would be helpful to you as a mentor?
THANK YOU!
I appreciate you taking the time to complete this form! If you need to reach out for any reason, please feel free to reach out via email danielle@anacortesfamily.org or phone/text 206-486-4819

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