NAME _________________________ COURSE ____________________ This log must be kept in conjunction with the contract assignment sheet.

The supervisor must validate student participation time and certify the hours for attendance by signature for each assignment. Participation hours on this sheet must be added and total entered at the bottom. The program coordinator must review and sign the completed report. The form will be used for attendance and accounting purposes. Date of Activity Description of Activity Hours

*Certification: To the best of my knowledge and belief, this report has been kept as required by law in accordance with the instructions of the Superintendent of Public Instruction. TOTAL WEEKLY HOURS: _________

__________________________________________ ______________ Program Coordinator

Date