Tutor:

Address/Phone Changes?:

Current Email Address:

Student:

Address/Phone Changes?:

Current Email Address:

Report For Months (Check All that Apply):

January February March April May June

July August September October November December

*Summary of Hours for Period*

(Total in hours--Please round off to the nearest half hour)

Tutor (Total In Hours)

Tutoring Time:

Preparation:

Travel:

Student (Total In Hours)

Tutoring Time

Self Study:

Travel:

Other Student-Tutor Activities:

*Student Goals*

Goal Completed:

New Goal Started:

Tutoring Stopped

Date Tutoring Stopped:

Reason(s) Stopped:

Specify if Tutor or Student has stopped:

Student Achievements:

Educational-Check all that apply

Entered ABE or ESL Class

Got GED

Entered Community or Technical College

Increased Computer Literacy

Earned Employer, Company, Industry or Other Related Certificate

Improved Literacy Skills-Oral or Written

Improved Basic Math Skills

Comments:

Other

Societal-Check all that apply

Earned U.S. Citizenship

Registered to Vote or Voted

Knows, Uses More Community Resources

Gained Survival Skills

Other

Economic-Check all that apply

Gained Employment

Retained Employment

Advanced in Job/Got a better job

Improved Employability Skills

Improved Job-related Math Skills

Comments:

Other

Parenting/Family Literacy-Check all that apply

Reads more to Child

More Involved in Child's School

Gained Child Development Knowledge

Child's Teacher Reports Child's Improvement at School

Improved Family Management Skills

Skills for wellness/healthy lifestyle

Improved Family-related Math Skills

Comments:

Other

Other(explain below)

We are now working on the following books:

Tell us what skills you've been working on:

What materials & activities will help you accomplish new goals?

Call WLC at 647-3264 with questions.