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Tutors Name:

Reporting Month:
January February March April May June July August September October November December

Year:
2006 2007 2008 2009 2010

Students Name:

Number of times met this month:

Number of Instructional Hours this Month:

Number of Lesson Prep Hours:

Number of Driving Hours:

Number of In-Service Hours:

Other Hours (i.e. committees, waiting for student, board meetings, etc.):

Materials used this Month:

Title of any completed workbook(s):

Tutor Comments or Requests:

Student information that should be updated:  Help/More Info

My Student and I worked on the following (Check all that apply):
Reading
Finding #s in phone book
Map skills
check-wirting
balancing checkbook
medical/health/RX vocabulary
job application skills
reading newspaper
writing letters
ATM usage skills
Dictionary skills
restaurant/food vocabulary
Email skills
Computer skills
Library Skills
Pronunciation
Listening Skills
Math Skills (describe below)
Other Skills (describe below)

Describe Math/Other skills :

My Student got: (check all that apply):
Better Job
Raise In Pay
Promotion