ARKANSAS YOUTH CHALLENGE
ATTN: PRO, PO BOX 41, Camp J.T. Robinson,
North Little Rock, AR 72199

Phone: 1-800-814-8453
Fax: 1-501-212-5305

MENTOR MONTHLY REPORT  (due by the 15th of each month)

To download, print, and mail or fax the monthly report please follow the download link at the bottom of this page.





Platoon (required)

Report Date (required)

Reporter Name (required)

Reporter Email (required)

Reporter Phone (required)

Reporter Address

Reporter City,State,Zip

 

 

Cadet Name (required)

Cadet Email (if changed)

Cadet Phone

Cadet Address (if changed)

Cadet City,State,Zip (if changed)

   

Type of Contact

Did you meet contact requirements? Yes No 

(4 contacts, or 4 hours of contact, or a combination thereof with the Cadet)

Dates

Specify Type of contact

 

 

 

 

 

Post Residential Placement Activity

Please check all boxes that best describes what your Cadet has been doing during the reporting month. Please write the dates that he/she enrolled in school, enlisted in a military service/shipped, or began working including employer’s name and wage amount.

Education

Enroll Date:

School Name:

Counselor:

Military Service

Enlist Date:

Ship Date:

MOS:

Miscellaneous

Employment / Volunteer

Hire Date

Company

Position

Wage

Part/Full Time

 Part Full

 Part Full

Supervisor Name and Phone #

Termination Date

Reason

Additional Comments

If your Cadet has made changes to his or her P-RAP (Post Residential Action Plan), please provide the following information: Specific changes to the P-RAP, the cadet’s expected outcome as a result of the changes; why the cadet made the changes; and the mentor’s position and rationale regarding the changes?

To download, print, and mail or fax the monthly report please follow this link: