Monthly Mentor Assessments
(For current MYCA Mentors only)
Mentor Name & Code:
Mentee Name:           

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Civilian Employment

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1. Is your mentee currently working? Yes No

2. If so, where are they employed?

   
3. How long have they been employed at this location?

4. Number of hours per week: Wage:

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Education

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5. Is your mentee currently going to college, trade school, adult

    education, high school or job corps? Yes No

 

6. If so, which one are they attending?

   

7. What is the name of the school they are attending?

   

8. How long have they been attending?
    Number of hours per week:             

 

9. What is the major they are studying?

   

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Military Service

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10. Has your mentee joined the Armed Forces?    Yes No

11. Are they in the process of joining the military? Yes No

12. If so, which branch? Not applicable Army National Guard Air National Guard United States Army United States Marine Corps. United States Navy United States Air Force United States Coast Guard
     Active Duty or Reserves?      Not applicable Active Reserves

13. What is their military occupational skill going to be?

    

14. What is their current status? Not applicable Basic Training Military Skills Training Active Duty Weekend Drills

15. What date did they leave or what date do they expect to leave?

    

16. If they joined the Guard or Reserves, what date are they expected to

     return from training?

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Weekly Contacts

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17. Contact Date:  Type of contact: Face to Face Phone Mail E-Mail

      Was it productive? Yes No

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18. Contact Date:   Type of contact: Face to Face Phone Mail E-Mail

      Was it productive? Yes No

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19. Contact Date:   Type of contact: Face to Face Phone Mail E-Mail

      Was it productive? Yes No

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20. Contact Date:   Type of contact: Face to Face Phone Mail E-Mail

      Was it productive? Yes No

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21. Contact Date:   Type of contact: Face to Face Phone Mail E-Mail

      Was it productive? Yes No

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Additional Comments: