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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 RoadFairbanks, Alaska  99701T: 907-456-6212F: 907-456-4302lca@literacycouncilofalaska.org
If selected Other, please specify:
If selected Other, please specify:
Improved reading skills
Improved writing skills
Improved English speaking skills
Improved math literacy skills
Improved computer literacy skills
Built citizenship skills
More involved in children’s schooling
More involved in children’s literacy
Received driver’s license
Obtained library card
Obtained a new job
Retained job
Improved current job
Obtained diploma or GED
Entered job training/educational program
Registered to vote/voted
Got off public assistance
Moved out of public housing
Received passing score on TOEFL