Match Report Form


Fill out the Match Report Form each year when your case manager's requests your feedback on your Little. The Match Report measures where your Little is now compared to one year ago.

Instructions: Fill in your name, email address, and match case manager's name in the appropriate boxes. Then, for each of the developmental areas, make a choice from the drop down box options (click on the down arrow and click on your choice):

  • Much Worse
  • A Little Worse
  • A Little Better
  • Much Better
  • Don't Know
  • Not a Problem
First Name
Last Name
Email
Coordinator


Confidence Status Description
1. Self-confidence A sense of being able to do or accomplish something.
2. Able to express feelings Is able to reveal, talk about, or discuss feelings.
3. Can make decisions Thinks before acting and is aware of consequences of behavior.
4. Has interests or hobbies Pursues activities such as reading, sports, music, computers, etc.
5. Personal hygiene, appearance Dresses appropriately and keeps self neat and clean.
6. Sense of the Future Knows about educational and career opportunities.

Competence Status Description
7. Uses community resources Partakes in service activities, libraries, recreation, church/other faith-based activities
  8. Uses school resources Uses the library, guidance counselors, tutorial centers
  9. Academic Performance Makes good grades or improving grades
  10. Attitude toward school Is positive about going to school and about what can be learned
  11. School preparedness (homework) Completes homework and other assignments
  12. Class participation Actively takes part in learning; responds to questions
  13. Classroom behavior Pays attention in class; isn't disruptive
  14. Able to avoid delinquency Refrains from behaviors that are illegal for person of his or her age
  15. Able to avoid substance abuse Doesn't use illegal or harmful substances
  16. Able to avoid early parenting Doesn't engage in sexual behavior likely to result in early parenting

Caring Status Description
17. Shows trust toward you Isn't reluctant to confide in you, to accept your suggestions
  18. Respect other cultures Doesn't stereotype or put down other ethnic, racial, language, or national groups
  19. Relationship with family Interacts well with other family members
  20. Relationship with peers Interacts well with persons of own age
  21. Relationship with adults Has good intentions with other adults who are not family members