Literacy Volunteers Of Rensselaer County
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Highlights: 1968-2013
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OLD Tutor Reporting Form (inactive)
Date
*
MM slash DD slash YYYY
Reporting Month
*
January
February
March
April
May
June
July
August
September
October
November
December
Year
*
2018
2017
2016
2015
2014
Tutor Information
Tutor's Name
First
Last
Tutor's Home Phone
Tutor's Cell Phone
Tutor's Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Student Information
Student's Name
First
Last
Student's Home Phone
Student's Cell Phone
Student's Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Match Status
Match Status
Active
Inactive
Terminated
If Currently Inactive, Reason?
Duration of inactivity and expected restart date:
Termination Date
MM slash DD slash YYYY
Does the student want another tutor?
Yes
No
Do you want another student?
Yes
No
Comments (If Needed)
Employment Status
Employment Status as of 7/1 (Start of Current Program Year)
Employed
Unemployed < 1 Year
Unemployed > 1 Year
Not in labor market
Retired
Date Job(s) Began
MM slash DD slash YYYY
Hours Per Week
Change In Employment Status
No Change
Obtained A Job
Lost Job
Change In Hours
Date Job(s) Began
MM slash DD slash YYYY
Hours Per Week
Change In Hours Per Week
Other Changes Affecting Family Income Or Needs
Goals For This Program Year
Goals change each program year. Past year goals are only relevant if not previously reported.
Before (As of 7/1)
Obtain A Job
Retain Job
Improve Job
Obtain GED
Enter Post-Secondary Education
Enter Training
Obtain Citizenship Skills
Increase Community Involvement
Vote/Register To Vote
Help With Children's Education
New (Since 7/1)
Obtain A Job
Retain Job
Improve Job
Obtain GED
Enter Post-Secondary Education
Enter Training
Obtain Citizenship Skills
Increase Community Involvement
Vote/Register To Vote
Help With Children's Education
Additional Goals
Additional Outcomes Achieved
Current number of children
(In school in the United States)
Pre-K
0
1
2
3
4
5
Elementary
0
1
2
3
4
5
Middle School
0
1
2
3
4
5
High School
0
1
2
3
4
5
Record of hours
Month
January
February
March
April
May
June
July
August
September
October
November
December
Prep Time
Total Time With Student
Travel Time
Instructional Strategies
What reading materials are being used?
What kind of writings have been done?
What LVA activities has the student participated in?
Other Comments/Student Accomplishments
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