The Literacy Council of North Central Indiana

Tutor/Student Monthly Hours Report

Kindly complete the form below on a monthly basis.

We would like your feedback! Use the open format comment areas for feedback.

Pairs Information:
Tutor name:	* required
Student name:	* required
Month Reporting:	* required
Instruction Hours: Prep Time: Travel Time:
Note any change of address or contact information for the student or tutor:
Goals, Achievements or Concerns:
Let us know if you are working on goals listed below or if you have achieved a goal:
Easy Checklist For Goals: Hold down cntrl key to select multiples	GED Placement in training program Complete educational functional level Achieve work based project goal Achieve citizenship Vote or register to vote Increase community activities Enter employment Retain employment Leave public assistance Increase involvement in childs education Help child with school Increase contact with childs teacher Increase involvement with childs literacy activities Read to child Visit and utilize library Purchase reading materials Read religious books ie Bible Torah Koran Write checks financial records Access public transportation