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
________________________