ArkCDA Mentor/Mentee Contact Form

You may enter contacts individually or as a summary (monthly, etc.). When finished click the Submit button. For your own records you will also need to print out and complete this Attendance Verification Form. ONLY CONTACTS RECORDED IN THIS DATABASE MAY BE VERIFIED AS PD HOURS.

 


*Mentor's Name:
*Mentee's Name:
*Contact Date (MM/DD/YYYY):

In the Subject box below, enter the subject of the contact followed by the amount of time (use increments of 15 minutes). If you are entering multiple contacts on this form you should enter the date, subject, and amount of time for each contact. At the end of the summary include the total time. EXAMPLE: 10/08/2008 - Region Tryouts - 15 minutes.
*Subject :
Verify Authentication Code: