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EnvironMentors Student Drop Form Today’s Date

_____________________________________________________

Student’s Name

______________________________________________________

School

______________________________________________________

Grade

______________________________________________________

Teacher

______________________________________________________

Address

______________________________________________________ ______________________________________________________

Phone

______________________________________________________

1) Results of in person and/or phone conversations to student/mentor/parent to inquire of difficulty and to support student in remaining with the program through the season. • • • 2) Student’s stated perspectives(s) for difficulties in staying with EnvironMentors.

3) Mentor’s perspective on student(s) difficulties in staying with EnvironMentors.

4) Student’s final reason for leaving EnvironMentors.

__________________________________ Student Signature

_______________________ Mentor’s signature

Effective Date of Termination

________________________


/F4-Student%20Drop%20Form_0  

http://environmentors.net/sites/default/files/F4-Student%20Drop%20Form_0.pdf

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