EmailMe Form - AMP Tutor Report

Session Date: *

MM / DD / YYYY

Student Name: *

Tutor Code: *

Approximate Start of Session:

Approximate Length of Session *

Miles Driven (Round Trip): *

Talk-Work-Play Distribution
(e.g. T-W-P-W-W-P-T-W) *

Student Skill Score (SSS) Data

Please answer the following SEVEN questions below as quickly as possible, and using your best judgement.

Q1. How well is the youth working/cooperating with you during the session?
(10=Very cooperative; 1=Not cooperative at all/Very distracted) *

Q2. How excited/enthusiastic was the youth in working during the sessions of the week?
(10=Very Enthusiastic and Participative; 1=Not Participative at all) *

Q3. How well is the youth grasping the material presented during sessions?
(10=Understands everything; 1=Did not understand a single topic) *

Q4. How easy was it to schedule and keep appointments for the week?
(10=Scheduling on time, session start on time, no rescheduling;
1=Had to reschedule multiple time, session started late/ended early, no show) *

Q5. How frequent were the visits in the last 3 weeks (3 is great, 1 or 0 is not so great)?
(10=THREE two-hour sessions per week; 1=No sessions prior to this in the last three weeks) *

Q6. Were you able to assess a positive difference in attitude in school and/or noted improvement in grades?
(10=Positive attitude change PLUS school/parent/student account of grade increase) *

Q7. How encouraging were parents/guardian of the youth's efforts, and of the tutoring being offered?
(10=Parents accessible, working space perfect, no interference during session;
1=Parents can't be reached, poor working space, interference during session) *

Materials Used

(One material listed per line please. It may e a book description outside of the student's regular book, an AMP Worksheet - please indicate number - or a link to a site of a pdf worksheet used.)

Report Summary

Please provide a summary of your session with the student (600 characters minimum, 1000 characters maximum) Note: If you need to add to your report, please use the additional section below. Thanks!

*

Additional Notes (OPTIONAL, 1000 characters maximum) Note: We recommend here that this section include any recommendations or changes about our group's approach to working with this youth.

Please check the box next to each of the statement below if it TRUE: *

(1) The student is CAPABLE of learning and VERY WILLING to learn.

(2) The Home-Decision Maker (HDM) has been VERY SUPPORTIVE in getting the student educational assistance services.

(3) When needed and If needed, the Case Worker has been ACTIVELY INVOLVED in getting sessions set up.

None of the statements above is true.

Notes: (A) If ANY of the first THREE BOXES are checked, this means that the FOURTH box should be UNCHECKED; (B) For the THIRD question relating to the case worker, this depends on whether there were scheduling problems AND the case worker duly intervened. If there was no intervention, then the box should be checked by default.