Volunteer Monthly Report
Tutor Name
*
First Name
Last Name
Tutor Phone Number
*
XXX-XXX-XXXX
Format: (000) 000-0000.
Tutor Email
*
example@example.com
Learner Name
*
First Name
Last Name
Change in Tutor or Learner Contact info? Please enter it here.
Learner is a
*
Select One
Native English speaker
Non-native English speaker
Our match is
*
Select One
Active
Inactive
On Hold
Please explain why
Learner is tutored for:
*
Please Select
Adult Basic Education
Career Pathways Program
Citizenship
ESL
GED Preparation
Volunteer Others
Other
Reporting period:
*
Select One
January
February
March
April
May
June
July
August
September
October
November
December
Hours spent tutoring
*
Hours spent preparing
*
Hours spent traveling
*
Hours in meetings, trainings, office work, etc.
*
Has your learner completed the health literacy pre-assessment?
*
Select One
Yes
No
Has your learner completed the health literacy post-assessment?
*
Select One
Yes
No
Yes, I would like to renew books from the LCS library: (Please enter 4 digit number and the name for each book here to renew)
Please enter 4 digit number for each book here to renew
Please verify that you are human
*
Submit
Should be Empty: