FORMS to be used for Walk With a Scholar Programme 2016-17

Form Title To be maintained by Purpose

A Attendance of Internal Mentor and For recording the attendance of
Mentees/Mentor for submitted to the mentees and Mentor of the
Internal Mentoring coordinator at the end Programme, session wise
Sessions of the semester

B Attendance of Coordinator To be obtained from mentees

Mentees- External attending External Mentoring
Mentoring sessions sessions

C Receipt for External Coordinator For the remuneration paid to the

Mentors External Mentoring Sessions
D Attendance of Coordinator Tobe obtained for External
External Mentors mentoring Sessions
E Receipt for Internal Coordinator To be obtained from Internal
Mentors Mentors on payment of the
remuneration for Internal mentoring
sessions
F Declaration of Internal Coordinator/Internal Declaration to be given by the
Member Mentor Infernal mentor on submission of
Activity Report & Faculty Diary
G Receipt of Coordinator Coordinator To be given by the Coordinator on
completion of the Programme for
the academic year.

H Activity Report of Internal member: To be For recording the activities

Internal Member submitted to the undertaken by the Internal mentor
coordinator at the end
of the Programme
I Feedback of Mentees- Coordinator For getting the feedback on each
External Mentoring external mentoring session
J Feedback of External Coordinator To be obtained from the External
Mentor Mentor after his/her session
K Status of Walk With a Coordinator To be submitted to the Office of the
Programme New Initiatives in by December 5
(Status as on 30.11.2016) and March 5
(Status as on 28 February, 2017)
L Statement of Coordinator Statement of Accounts related to
Accounts of WWS the Expenditure incurred, to be
prepared on completion of the
Programme (To be retained in the
College. Copy to be given to Office
of the New Initiatives by 10th April,
2017)
FACULTY DIARY Internal Mentor: To be To be maintained and kept updated
completed and given to by the Faculty Member
the Coordinator at the
end of the semester
 FORM: A

WALK WITH A SCHOLAR 2016-17

INTERNAL MENTORING SESSIONS

Attendance of Mentees/Mentor 2016-17

Name of the College:

Name of the Coordinator:

Name of the Mentor:

Semester:

Date and Time

Sl.
Name of Mentee
No.
Signature of Mentees
1

Mentors Signature

Coordinators Signature

Principal

(Use additional sheets if needed)

 FORM: B
WALK WITH A SCHOLAR 2016-17
EXTERNAL MENTORING SESSIONS
Attendance of Mentees 2016-17
Name of the College:
Name of the Coordinator:
Semester:
(Use separate/additional sheets for each year)

Date & Date & Date & Date & Date & Date &
Time Time Time Time Time Time
Sl. Name of
No. Mentee

Signature
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
External Mentors
Signature
Coordinators
Signature

Principal
 FORM: C

WALK WITH A SCHOLAR 2016-17

RECEIPT FOR EXTERNAL MENTORS

Received from ...(Coordinators Name

and Designation), Coordinator, WWS Programme,
..(Name of College), a sum of
Rs..(Rs...), for engaging
classes for hours fromto (.Sessions), in
connection with the External Mentoring Sessions of Walk With a Scholar Programme 2016-
17, held at .(College) on
.. (date)

Topic:

Place: Signature:

Date: Name:

Designation & Official Address:

 FORM: D
WALK WITH A SCHOLAR 2016-17

EXTERNAL MENTORING SESSIONS

Attendance of External Mentors 2016-17

Name of the College:

Sl Name of External Date of Class Session Total number Signature
No Mentor Timings of Sessions of of the
1 hrs External
duration Mentor

Coordinator Principal

Date:
 FORM: E

WALK WITH A SCHOLAR 2016-17

RECEIPT OF INTERNAL MENTOR

Received from Principal/ Coordinator, WWS Programme,

(College), a sum of

Rs .../- (Rupees Only) being the

honorarium for engaging sessions of Internal Mentoring of Walk With a Scholar

Programme for the academic year 2016-17.

Place: Signature:

Date: Name:

Designation:
 FORM: F

WALK WITH A SCHOLAR 2016-17

DECLARATION OF INTERNAL MENTOR

Name of the College:

I, (Name)

Internal Mentor of Walk With a Scholar Programme for 2016-17 hereby declare that (i) I have

submitted the Activity Report of Internal Mentoring for 2016-17 (ii) I have updated the

Mentors Diary for 2016-17

Place: Signature:

Date: Name:

Designation:

(To be submitted to the Coordinator of WWS at the end of the Programme before accepting
the remuneration)
 FORM: G

WALK WITH A SCHOLAR 2016-17

RECEIPT OF COORDINATOR

Received from Principal,...(College), a

sum of Rs /- (Rupees Only)

being the remuneration for functioning as the Coordinator of the Walk With a Scholar

Programme for the academic year 2016-17 in the College.

Place: Signature:

Date: Name:

Designation:
 FORM: H

WALK WITH A SCHOLAR 2016-17

ACTIVITY REPORT OF INTERNAL MENTORS FOR 2016-17

(To be submitted to the Coordinator of WWS at the end of the Academic Year)

Name of the College:

This is expected to be a consolidated report of the activities undertaken by the Internal Mentor during
the academic year. Attach Extra Sheets if needed.

1 Name of the Mentor

2 Designation Asst/Associate Professor/FDP Sub/Guest Faculty

of

.(Subject)
3 Mobile No & Mail id M:

Id:
4 Name, Semester & Subject of
Mentees assigned to the Mentor in
2016-17
(as on 1.3.2017)
Name Semester & Subject
(i)

(ii)

(iii)

(iv)

(v)

(vi)

5 Have you collected the bio-data of Yes/No

the mentee and filed them?

6 How frequently do you meet your

mentees (Put tick mark)
(i) Daily
(ii) Weekly
(iii) Monthly
(iv) Available always
7 When do you do the mentoring
activities
(i) As per mentor convenience
(ii) As per mentee convenience
8 Do you assign any specific task to Yes/No
your mentees?
9 If yes, what tasks have you assigned
(i)
to the mentees?
(ii)
(iii)
(iv)
10 What are the types of issues handled
by you in the process of mentoring
(i) Family issues
(ii) Academic issues
(iii) Career options
(iv) Personality problems
(v) Communication skills
(vi) Strengths
(vii) Weakness
(viii) Relationship problems
(ix) Others (Specify)

11 How many hours of Internal

Mentoring have you done this year
as on date?
12 Do you make any assessment of the Yes/No
progress of the mentee?
13 If yes, the methodology adopted

14 Did you observe any Yes/No

progress/change in any of the
mentees due to the mentoring Number:
process? If yes, write the number
also
15 Have you attended any external Yes/No
mentoring sessions during 2016-17
16 If Yes, how many?
17 If No, the reason for not attending

18 Your suggestions for improvement of the Programme

(i)

(ii)

(iii)

(iv)

19 Date 20. Signature

 FORM: I
Walk With a Scholar (WWS) Programme 2016-17
Feedback of Mentees- External Mentoring
( )

Name of the College:

Date: Time of Session:

Name of Resource Person:

Topic of the Session:

Feedback Form (Put a mark) ( )

1 General Remarks and Comments on the session Excellent Very good Good Average Poor
( ( ( ( () ()
) )
) )
2 Relevance of the Topic (
)
3 Variety of the Topic (
)
4 Plan of the Session (
)
5 Presentation of the Topic ( )
6 Interaction ( )
7 Overall rating of the session
(
)
8 Was this topic handled in an earlier class? Yes - No -
( ?)
(put a Circle around the word) (
)
9 Did you get anything new from the session ( Got - Did not get -

?)

(put a Circle around the word) (
)
10 Would you recommend another session by this Yes - No -
resource person? (
?) (put a Circle around the word) (
)
11. What are the salient features you observed in the class? ( )

12. Do you have any suggestions for the improvement of the session? (
?)
Name of the Mentee with Class and Subject:
FORM: J

Walk With a Scholar (WWS) Programme 2016-17

FEEDBACK OF THE EXTERNAL MENTOR

Name of the College:

1 Name of the External Mentor

2 Designation and address of the External Mentor

3 Mobile Number

4 Mail Id

5 Date and Time of Mentoring Session(s) Date:

Time:
6 Topic of Mentoring Session

7 Whether the topic was proposed by the Proposed by the College: Suggested by me:
College/Suggested by you
8 Interest and involvement shown by the students Very much: To some Extent:
in General
Average: Poor:
9 Interaction by students Very much: To some Extent:
Average: Poor:
10 Did the students ask Questions/Clarifications Very much: To some Extent: Not at all :

11 Attitude of the students in General Positive: Negative: Indifferent:

12 Could the session be completed as per your plan? Yes: No:
13 If No, reason for the same

14 Was the session predominantly activity Oriented or Activity Oriented: Lecture type:
Lecture type
Mixture of both:
15 Were the facilities provided in the class room Yes: No:
sufficient for effective transaction?
16 If No, the limitation(s) you had noticed

17 Suggestions for improvement

18 Your views about the Programme

19 Signature of the External Mentor

Form: K

Walk With a Scholar (WWS) Programme 2016-17

STATUS OF WWS

(As on .)

Semester:

1. Name of the College

2. Name of the Coordinator of WWS Programme

3. Number of students enrolled for WWS Programme

for Semester:
4. Details of Internal Mentoring sessions engaged as
on
Name of Internal Mentor Department No of Sessions
Department engaged

(i)

(ii)

(iii)

(iv)

(v)

5.
Funds utilized as on.

6. Signature of the Coordinator

7. Signature of the Principal

 8. Date

Form: L

Walk With a Scholar (WWS) Programme 2016-17

Statement of Accounts of WWS

(To be prepared at the end of the academic year)

Name of the College:

Name of Coordinator:

Voucher Bill/Receipt Details (No, Firm, Item(s)/Activity , date Rate/Unit Amount Remarks
No etc) (specify unit) (Rs)

Date:

WWS Coordinator PRINCIPAL