Literacy Volunteers of Rensselaer County NY
QUARTERLY STUDENT PROGRESS REPORT

Online version of the Student Progress Report form. (Form Updated: November 2005)

NOTE: Use the "TAB" key or your mouse to navigate from field to field. DO NOT hit the "ENTER" key.

If you have a non-AOL email address a summary copy of this report will automatically be sent back to you via email...so please make sure you enter YOUR EMAIL address correctly. Because of changes made by AOL there is no guarantee that you will receive a copy via email if you have an AOL email address...so you may want to print out a copy for your records before hitting the "SUBMIT" button.

Verify the Reporting Period and the Reporting Year.

Click on the "SUBMIT" box at the end of the form to submit the completed form. Thank you!

SELECT the Reporting Period:    SELECT the Reporting Year:
Type: (check all that apply)
BL  ESOL  One-to-One  Small Group  

Your name...............:   (Required)
Your email address......:   (Required)
Your phone (H)..........:    (W).....: 
Your address (if new)...:   

Student's name..........:   (Required)
Student's address.......:   
Student's phone (H).....:    (W).....:
Student marital status is: Single Married Divorced Widowed Unknown
Number of children:

Employment Status:
(check PREVIOUS if same as last quarter; check NEW if changed or use No Change category to report no new employment.)
Category Previous New
Employed - Full Time
Employed - Part Time
Unemployed
Not in labor market
No Change in Employment  
Category Previous New
Disabled
Living in rural area**
Retired
On public assistance*  Type: 









* Public Assistance Type Examples: TANF, Food Stamps, WIC, Old Age Assistance, Safety Net, Aid to Blind, Other (Please identify)
 ** Less than 2,500 inhabitants
Public Assistance change: No Change Lowered Public Assistance Off Public Assistance

Student is enrolled in: LVA Literacy Even Start
Date you last retested:  // [Mo./Day/Year XX/XX/XXXX] : report only if done this quarter - each student needs to be retested by June or before leaving the program) in order to be counted.

BL student level on READ test:   A B C D None
BL student tested on TABE test:   Level:  Form: Raw Score:
ESOL student on Best Plus test:   Score:

Termination date: // [Mo./Day/Year XX/XX/XXXX]
Termination reason:

Primary Goal (check only one):
Improve Basic Literacy Skills Improve English Literacy Skills
Secondary Goal:
Quarterly Time Reporting
SELECT MonthPrep
Time		TutoringContact
Hours		 Travel
Time		Student
Homework
Total
NOTE: Contact hours are time spent with your student other than tutoring.
Please report ALL time in quarter hour increments, e.g. one and a quarter hours = 1.25, two and half hours = 2.50, etc. Time should be rolled-up to the next quarter hour increment, e.g. 25 minutes is reported as .50, that is 1/2 hour.
Family & Self:
(check BEFORE if shows proficiency; check NEW if shows progress this quarter)
Category Before New
Reads to Children
Follows directions more easily
Understands medical/dental forms
Reads medication bottles
Reads for enjoyment
Improved communications with school
Helps children with homework
Conversed with family/friends in English
Category Before New
Described symptoms of an illness
Has increased self-confidence
Volunteered in school
Wrote to family/friends
Interpreted & paid bills
Improved parenting skills
Follows recipes















Other:

Education/Work:
(check BEFORE if shows proficiency; check NEW if shows progress this quarter)
Category Before New
Obtained GED
Completed job application
Obtained employment
Reads work-related materials
Fills out forms
Entered educational program
Communicates with peers/supervisors
Category Before New
Retained employment
Reduced public assistance amount
Reads/understands signs
Improved current job status
Understands work manuals
Obtained certification/license














Other:

Citizen:
(check BEFORE if shows proficiency; check NEW if shows progress this quarter)
Category Before New
Interpreted maps/schedules
Participated in a community organization
Received citizenship
Used library to gather information
Used telephone book & phone
Category Before New
Voted
Obtained driver's license
Applied for citizenship
Used postal service











Other:
Reading materials being used?  
Writings that have been done?  
LV activities participated in?

  Comments and/or Questions..............:


   
If you have any questions click to email me  or call 274-8526. Thanks, Tutor Coordinator
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