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Tutor Reporting Form – Troy
Dan Fennell
2022-09-10T22:29:30-04:00
1
Tutor Information
2
Student Information
3
Hours Of Service
4
Instructional Strategies
5
Student Employment Status
6
Program Goals
Tutor Information
Tutor Name
First
Last
Tutor Email
Are there any changes to the tutor’s name, address, email or phone number?
Yes
No
New/Updated Information
Student Information
Student's Name
First
Last
Are there any changes to the student’s name, address, email or phone number?
No
Yes
New/Updated Information
Hours of service delivery in reporting month
Date this report is made
MM slash DD slash YYYY
Reporting for this Month
January
February
March
April
May
June
July
August
September
October
November
December
Reporting for this Year
2024
2025
Tutor preparation time (hours)
Total Time with Student (hours)
Tutor travel time (hours)
Instructional Strategies
What reading materials are being used?
What writings have been done?
What LVORC activities has the student participated in?
Additional comments or student accomplishments.
Student Employment Status
Are there any changes to the student’s employment status?
No
Yes
Please check appropriate box and use field below to add additional information
Newly employed
Newly unemployed
Working full time
Working part time
Not employed outside the home
Additional Information
Goals For This Program Year
Are there any changes to the student’s learning goals, or life goals?
No
Yes
Program goal changes
Δ
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