Mentor Monthly Report – Oahu | Youth Challenge Academy

Step 1 of 6

Contact Information

Report period Start date(Required)

Report period End date(Required)

Graduate(Required)

First Last

Class(Required)

Mentor(Required)

First Last

Mentor Phone(Required)

Contacts per month with graduate(Required)

Where is the Graduate living?(Required)

Graduate Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Graduate Phone(Required)

PRAP

First Option(Plan A)(Required)

Second Option(Plan B)(Required)

Long Term Goal(Required)

List any changes to Placement options

What does Graduate expect to gain from changes?

Why did Graduate make the Change?

What is your position on the changes?

Graduate Status(Required)

Higher Education

Employed

Military

Higher Education

Name of School(Required)

Subject(Required)

Status(Required)

Part Time

Full Time

Date Started(Required)

Date Ended

If ended, why?

Employment Information

Name of Employer(Required)

Duty Title(Required)

Name of Supervisor(Required)

First Last

Supervisor Phone(Required)

Wage/ Salary(Required)

Number of hours per week(Required)

Status(Required)

Part-time

Full-time

Date Started(Required)

Date Ended

If ended why?

Military

Branch(Required)

Date of Enlistment(Required)

Ship Date(Required)

Type of Enlistment(Required)

Active Duty

Reserves

National Guard

Meeting Information

Contact Date(Required)

Type of Contact(Required)

Phone, Person, Letterm E-Mail, etc....)

Brief Summary(Required)

Contact Date

Type of Contact

Phone, Person, Letterm E-Mail, etc....)

Brief Summary

Contact Date

Type of Contact

Phone, Person, Letterm E-Mail, etc....)

Brief Summary

Contact Date

Type of Contact

Phone, Person, Letterm E-Mail, etc....)

Brief Summary