Next Steps of

South Carolina (NSSC)

Participant/Samaritan Mentor Visit Form

 

Participant: ______________________________________

Samaritan Mentor: _________________________________________

Today’s Date: ______________________________

Goal Please use one of the 63 Goals within the five categories in the Charity Tracker Plus Database: (1) Basic Needs, (2) Basic Skills, (3) Increase Income, (4) Gain and Sustain Assets, and (5) Health.  If all of these fail to describe the Participant's Goal, create a New Goal within one of the five goal categories in the Database.  As you record the Goal, please include the alpha-numeric designation, e.g., "A3" AND the full name of the Goal, e.g., "Complete the Benefit Bank Application".

Next Step Please use short action-oriented phrases with VERBS to define each “next step”, e.g., “GO TO Facility/Agency ABC” This will make it easier to measure outcomes through reports for the Affiliate’s management and grant-writing purposes.

Status There are 10 status categories within the Charity Tracker Plus database: (1) No Status, (2) Currently Participating, (3) Did Not Complete, (4) Did Not Qualify, (5) Enrolled), (6)Pending, (7) Received Assistance, (8) Waiting List, (9) Complete, and (10) Not Applicable.  Please select and write one of them.  If this is the FIRST Next Step within a Goal, please select "No Status". As a Participant delves deeper and deeper into his/her Next Steps within this Goal, you can select from among the other statuses. 

Due Date Please select and write a date based on the best guess, e.g., 1-week, 2-weeks, 3-weeks, etc. by which you and the Participant believe s/he can complete this Next Step.

Email Notification 5-Days before the Due Date of each Next Step, the Samaritan Mentor will receive an email about the upcoming action date for the Next Step. The Samaritan Mentor should please call the Participant to remind him/her to take that Next Step.

Notes: Please explain why you are sending the Participant to this employment or social service resource organization.

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Last Modified: 8/3/2017