Mentor Session Feedback Form
(C)2017 Edition
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date Picker Icon
Mentee Name
*
First Name
Last Name
School
*
Please Select
Alice Maxwell
Dorothy Lemelson
Double Diamond
Greenbrae
Glenn Duncan
Katherine Dunn
Lincoln Park
Lois Allen
Mt. Rose
Rita Cannan
Robert Mitchell
Time
Please Select
Before School (AM)
After School (PM)
Where did the session take place?
Please Select
School Library
Computer Room
Cafeteria
Classroom
Hallway
Which reading resource(s) did you use during the session?
Electronic Device (Kindle/Computer)
Hard Copy Book
Big Universe
Activity Worksheet
Other
Did you use word study? If yes, what game?
Did you use word study game? Please choose below.
ABC Order
Bingo
Concentration/ Memory Game
Create a Story
Go Fish
Hangman
Mind Reader
My Pile-Your Pile
What was the focus of the mentoring session?
Reading Fluency
Vocabulary
Retention
Comprehension
Relationship Building
Other
What did you do during today's session?
What are some of the goals you and your mentee have set ? How do you plan to achieve those goals?
Were any or some of the goals met during the session?
What are areas or is an area you feel your mentee needs extra attention in?
Overall how was the behavior and attitude of your mentee during the session? (Check all that apply)
Focused
Excited
Attentive
Frustrated
Exhausted
Unfocused
Motivated
Inappropriate
Engaged in task
Other
Please rate the following:
Disagree
Somewhat Disagree
Neutral
Somewhat Agree
Agree
N/A
Has your mentee's reading improved since your last session?
Has 360 Blueprint provided you with all the necessary tools & resources in order to have a successful mentoring session?
Has your assigned school site provided you with all support needed to have a successful mentoring session?
Please add any additional comments, issues, questions or requests that can help improve future mentoring sessions.
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