STUDENT NAME:  _____________________________

 

WORKSITE:  ____________________________________________________________

 

SUPERVISOR _________________________   WORK TELEPHONE  _________________

 

 

Record number of hours worked each day and document what you did while at work.

(This counts as your journal)

                                   

FOR WEEK OF:  ___________________________________

                                                           

SUN              MON           TUE            WED           THUR            FRI             SAT          TOTAL

EX:  2-5

 

 

 

 

 

 

 

 

 

Describe weekly activities: ____________________________________________________________________________________________________________________________________________________

 

                                   

FOR WEEK OF:  __________________________________

 

  SUN              MON           TUE            WED           THUR            FRI             SAT          TOTAL

 

 

 

 

 

 

 

 

 

 

Describe weekly activities: ____________________________________________________________________________________________________________________________________________________

 

                                                                                    Total Biweekly Hours           ____________

                                                                                                                       

_______________________

SUPERVISOR SIGNATURE

 

NOTE:  It is the policy of the school district that no person on the basis of race, color, religion, national origin or ancestry, age, sex, marital status, handicap, or disadvantage should be discriminated against, excluded from participation in, denied the benefits of or otherwise be subjected to discrimination in any program or activity.