FY22 Final Traditional Report Form
School District Name
Parent Mentor's Name
First Name
Last Name
Parent Mentor's Email
example@example.com
2nd Parent Mentor's Name (if applicable)
First Name
Last Name
Email for second Parent Mentor (if applicable)
example@example.com
Parent Mentor Partnership Region
Northwest
Northeast
Metro
Middle
Southwest
Southeast
1. Did 100% of your target families complete a Pre and Post Family Survey by April 15, 2022?
Yes
No
2.Describe your initiative. Include what student outcomes your work aligns with. (This may be an alignment with your district or a collaborative community initiative.)
3. How many years have you focused on this initiative?
1
2
3
4+
4. Select the E2P areas that your target work impacted
Graduation
Post-secondary Success
IEP Participation/Self-determination
Partnership/Stakeholder Engagement
Attendance/Academic Performance/Behavior
5. How did you and/or your partners address any concerns or needs that you identified by: Listening to families, looking at survey responses, or observing the actions (Vital Behaviors) families took? (did you have to pivot?)
6. Describe your Target Group Training. Include the following FORMAT, CONTENT, PARTNERS (and their role), and FAMILY LEARNING/ACTION/STUDENT SUCCESS MESSAGE. (You may answer as a narrative or give a bulleted response. This answer should provide the details needed for replication)
7. List TRAINING TOOLS and RESOURCES (handouts, lists, websites, etc.) you used to train or support your target group.
8. Number of Families Impacted
5
6
7
8
9
10
11
12
13
14
15
Other
9. Number of Students Impacted
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Other
10. List the two Learning Targets you used this year.
11. Did 100% of your target families learn what you intended? (This is the goal we are striving to meet so we are certain families are equipped to do the action [vital behavior])
Yes
No
12. If no, why?
13. How did you collect the learning target data? (This is the information you used to determine if the target families learned what you intended.)
14. Describe the action (Vital Behaviors) your target families took to practice what they learned.
15. Report the number or percentage of families who successfully completed the actions. (Action Data)
16. What student achievement outcomes did you expect to see based on the information you shared (Training) with families and the actions you supported them in doing?
17. What student achievement data do you have that documents that students were impacted by the action (Vital Behaviors) that families took (Family Engagement)?
18. Obstacles: Describe any obstacles you met related to inputs, processes, or target group/partners.
19. Solutions: Describe solutions you and your partners put in place to address the obstacles you mentioned above.
20. Recommendations: List suggestions you would give to another school district or parent mentor who would like to replicate your work.
21. Building Capacity is the process of developing strength and sustainability for our work by building a strong FOUNDATION, cultivating strategic RELATIONSHIPS, and being able to measure our EFFECTIVENESS and the IMPACT we are making on families. Here are some examples of strategies for building capacity you may recognize in your work: improving communication, improving information sharing, improving engagement of volunteers and partners, shared leadership, effective use of media outlets and identifying, utilizing and sharing data outcomes. Based on the above definition, did you build capacity this year?
Yes
No
22. Describe what you did to build capacity and how will it lead to long-term impact.
23. Is there additional information that you would like to share about your family engagement work?
Submit
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