Sample Mentoring Program Coordinator Weekly Tracking Form



SAMPLE MENTORING PROGRAM COORDINATOR SUMMARY

WEEKLY ACTIVITY TRACKING REPORT

Program Coordinator Completing Form: ________________________________

Report Date: _______________________ Reporting Period: _______________

|Mentors Submitting Weekly Reports |Number of mentors submitting reports |

| |Number of weekly reports submitted |

| | |

|Mentees Reflected in Weekly Reports |Number of mentees |

| | |

|Number of Mentees Tracked Per Targeted |Antisocial Behavior |

|Behavior |Family Problems |

| |Social Competence |

| |Gang Involvement |

| |Alcohol and Drugs |

| |School Attendance |

| |High School Graduation |

| |Low Grade Point Average |

| |Perceived Access to Social Services/Support |

| | |

|Mentors Indicating Changes in Targeted | |

|Behaviors |_____ Number of mentors indicating changes in behaviors |

| | |

|Number of Mentees Who Participated in or |Participated |Completed |

|Completed Evidence-based Programs |Project Learn |Project Learn |

| |SMART Leaders |SMART Leaders |

| |Gang Prevention Through Targeted Outreach|Gang Prevention Through Targeted Outreach |

| | |

|Mentees Who Participated in BGCA-approved |_____ Number of mentees who participated in BGCA- |

|Programs or Activities | |

| |approved programs or activities |

| | |

| | |

|Mentees Who Participated in Other Activities |_____ Number of mentees who participated in other activities |

|or Events |or events |

| | |

| | |

|Challenges, Issues or Concerns |List of challenges, issues or concerns: |

| | |

| | |

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