PMP - Peer Mentor Visitation Form

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Peer Mentor Visitation Form

The fields that have an * beside them, are required before submitting this form.

Email Address:

Due Date:

Each Peer Mentor is expected to complete this form after each visit with each of his/her assigned Mentee(s) and submit it on the due date to the AASAC Office.

Mentor Name:
(Last, First Middle Initial)

Mentor Phone #:
ex. (xxx) xxx-xxxx

Team Leader:

Team Leader Phone #:
ex. (xxx) xxx-xxxx

Were any problems or areas of concern reported during the visits?	Yes No

If YES, please email Dr. Tracy Ray or Felicia Baity. Or, call 515-3835.

MENTEE 1

Mentee Name:

Mentee Phone #:
ex. (xxx) xxx-xxxx

Date of Visit:

Place of Visit:

Type of Visit:

COMMENTS
(Items/Topics Discussed or Discovered)

Academic/Personal Achievements:

MENTEE 2

Mentee Name:

Mentee Phone #:
ex. (xxx) xxx-xxxx

Date of Visit:

Place of Visit:

Type of Visit:

COMMENTS
(Items/Topics Discussed or Discovered)

Academic/Personal Achievements:

MENTEE 3

Mentee Name:

Mentee Phone #:
ex. (xxx) xxx-xxxx

Date of Visit:

Place of Visit:

Type of Visit:

COMMENTS
(Items/Topics Discussed or Discovered)

Academic/Personal Achievements:

List any resources that you have recommended to your Mentee(s). Please indicate beside each resource in parenthesis which Mentee was referred. If appropriate give staff name, also.

Example:

(mentee # from above) - (resource recommended) - (staff member)

(1,3) African - American Student Affairs => Ms. Tracey Ray

Last Updated: August 17, 2008