Literacy Council of Alaska - Quarterly Report Form

Tutor Report Form

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Quarterly Tutor Report Form

Quarters are as follows: 1st Jul-Sept; 2nd Oct -Dec; 3rd Jan-Mar; 4th Apr -Jun

Date Report is being Submitted

MM/DD/YYYY

Reporting Period Select One

First / Last Name First / Last Name

Tutor:

Student:

P.O.Box OR Street / City , State / Zip

Mailing Address:

Phone:

(Use format xxx-xxx-xxxx)

Select One

Progress Report:

Using lessons pertaining to student’s job?

Select One

What Successes/Improvements Have You Noticed? (check all that apply)

If your student has discontinued tutoring, please select the relevant item:

Select One

If you have discontinued tutoring, please select the relevant reason:

Select One

Is there anything we can help you with? More to share? Enter comments in the Box on the Right. Thank You!

Month 1

Enter Month data is for

Preparation Time

Enter Prep. Time

Hours Tutored

Enter total Hours for Month 1

Year

Enter Current Year

Travel Time

Enter Month 1 travel time

Month 2

Enter Month data is for

Preparation Time

Enter Prep. Time

Hours Tutored

Enter total Hours for Month 2

Year

Enter Current Year

Travel Time

Enter Month 2 travel time

Month 3

Enter Month data is for

Preparation Time

Enter Prep. Time

Hours Tutored

Enter total Hours for Month 3

Year

Enter Current Year

Travel Time

Enter Month 3 travel time

Literacy Council of Alaska

517 Gaffney Road

Fairbanks, Alaska 99701

T: 907-456-6212

F: 907-456-4302

lca@literacycouncilofalaska.org

If selected Other, please specify: