Mentor Evaluation of the Student

Mentor, please mail this Evaluation form at the end of December to:

Attn: Gitashree Chakraborty, C/O The Lily Foundation

42/12 NSC Bose Road, Regent Park, Kolkata – 700 040

1. Student Name: _____________________________________________

2. Review Year [ex. 200X]: ____________

3. How do you characterize the Student’s general conduct?

[Choose one - Outstanding, Good, Fair, Bad]: ________________________

4. Accomplishments of the Student (outside academics) as you know – Be specific [Examples: leadership in social/community events, participation in contests such as musical, debate and others, earning outside to help the family or helping parents to earn]:

5. General comments [Any significant trend you noticed in the student – good or bad, or anything you want to tell us – suggestions, concerns etc.]

____________________________ _______________

Mentor Signature Date

(& Name if signature is hardly legible)

________________________________________ _________________

Current address Phone or email we can

contact in case of need

Lily Foundation appreciates time, effort or money you contributed in this evaluation process. Please continue to encourage the student to excel, and remind him/her to send the annual score to Lily India as soon as it is available.

Note: Instead of this form, if you want to use your own pad or computer print-out, feel free to do so. You may also email the Evaluation, if convenient, to: jpsarkar@hotmail.com