Sample Mentee Tracking Form

SAMPLE MENTEE TRACKING FORM

Project Coordinator: ______Grant: ______Reporting Period: ______

Name Date Served Completed Commitment Mentor Name Dates of Completed Retained Exited Recruited by Pre- and Dates Support and Follow- Program from the Before the Minority Post- up Activities Requirements Start of the End of the Male training From___ - To__ Reporting Reporting surveys Period Period

1.  Yes  Yes - 2.  Yes  Yes  Yes  No  No 3.  No  No  No 4. 1.  Yes  Yes - 2.  Yes  Yes  Yes  No  No 3.  No  No  No 4. 1.  Yes  Yes - 2.  Yes  Yes  Yes  No  No 3.  No  No  No 4. 1.  Yes  Yes - 2.  Yes  Yes  Yes  No  No 3.  No  No  No 4. 1.  Yes  Yes - 2.  Yes  Yes  Yes  No  No 3.  No  No  No 4. 1.  Yes  Yes - 2.  Yes  Yes  Yes  No  No 3.  No  No  No 4. 1.  Yes  Yes - 2.  Yes  Yes  Yes  No  No 3.  No  No  No 4. 1.  Yes  Yes - 2.  Yes  Yes  Yes  No  No 3.  No  No  No 4. 1.  Yes  Yes - 2.  Yes  Yes  Yes  No  No 3.  No  No  No 4.

Mentoring at Boys & Girls Clubs Distance Learning Course Page 1 of 1 12.22.2010