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Required Mentor Monthly Report
Mentee (Client)Mentee's full name
DOC#

Mentee Visits

DateClick to select a date
date_range
DurationLength of visit
LocationLocation of visit
0 /
DateClick to select a date
date_range
DurationLength of visit
LocationLocation of vist
0 /
DateClick to select a date
date_range
DurationLength of visit
LocationLocation of visit
0 /
DateClick to select a date
date_range
DurationLength of visit
LocationLocation of visit
0 /

Mentee Communications
(Phone conversation; Written: text, e-mail, letter)

DateClick to select a date
date_range
DurationDuration of communication
DescriptionDescription of communication
0 /
DateClick to select a date
date_range
DurationDuration of communication
DescriptionDescription of communication
0 /
DateClick to select a date
date_range
DurationDuration of communication
DecriptionDescription of communication
0 /
DateClick to select a date
date_range
DurationDuration of communication
DescriptionDescription of communication
0 /

Did you discuss any of the following resources with your Mentee?
If "Yes," please list

Recovery ResourcesEnter summary of conversation
0 /
Housing ResourcesEnter summary of conversation
0 /
Job Training/ReadinessEnter summary of conversation
0 /
Family ReunificationEnter summary of conversation
0 /
Community, Faith ResourcesEnter summary of conversation
0 /
OtherEnter summary of conversation
0 /

Are you and/or your Mentee attending any support groups?

Myself
Support GroupsName support groups
0 /
Mentee
Support GroupsName support groups
0 /

Did you attend any Continuing Education classes this month?

Select one
Continuing EducationList any classes you attended
0 /

Do you need any of the following?

Check all that apply

IF YOU HAVE ANY QUESTIONS OR NEED ASSISTANCE

AfterCare Office: 412-321-3343 Meghan Briggs, Director: mbriggs@foundationofhope.org Brittany Buttry-Watson, Assistant Director: bbuttrywatson@foundationofhope.org Fran Morrow, Administrative Assistant: frances.morrow@alleghenycounty.us

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