Submit Conversation Log
Peer Leader:
Date of Conversation:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
01
02
03
04
05
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07
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09
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31
2007
Have you had a Friend to Friend conversation with this person before?
Yes
No
Did you initiate the conversation or were you approached?
I initiated
I was approached
Location of the conversation:
On-line Chat
Home
School
Work
College Group Meeting
Phone
Bar or Coffee Shop
Other
(Other:
)
Level of conversation:
Level 1: Superficial
Level 2: Information Exchange
Level 3: Expression of Feelings
Level 4: Deepest Intimacy
Discussed high risk practices?
Yes
No
Discussed safer-sex practices?
Yes
No
Personal endorsement:
Yes
No
Comments:
(include referrals made)