<p> SAMPLE MENTEE TRACKING FORM</p><p>Project Coordinator: ______Grant: ______Reporting Period: ______</p><p>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</p><p>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. </p><p>Mentoring at Boys & Girls Clubs Distance Learning Course Page 1 of 1 12.22.2010</p>