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Mission Statement

Achieving better mental health in Tippecanoe County

Did You Know

One of out of four families are impacted by mental illness.

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Compeer Match Monthly Report Form

       
     

Your Name:
Friend's Name:
Report Month:

Compeer Match Meetings this Month:
 
1) Date:
  Number of Hours with Friend:
  Activity:
 
2) Date:
  Number of Hours with Friend:
  Activity:
 
3) Date:
  Number of Hours with Friend:
  Activity:
 
4) Date:
  Number of Hours with Friend:
  Activity:
 
5) Date:
  Number of Hours with Friend:
  Activity:
 
During this month have you had to cancel or reschedule a meeting?
Yes   No
 
Have you had difficulty reaching your friend?
Yes   No
 
Phone Calls:
 
1) Date:
  Length of Call:
 
2) Date:
  Length of Call:
 
3) Date:
  Length of Call:
 
4) Date:
  Length of Call:
 
5) Date:
  Length of Call:
 
Comments and Concerns:
 
Email Address: