For Coconino County
Adult Probation
Officers only:

Please select here
to print the Partnership for Literacy Rehabilitation (PLR) Coconino County Adult Probation Referral Form.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

One-to-One
Monthly Reporting Form


Please fill in this form after your last meeting of each month, and submit it by the first week of the next month.

 

One-to-One Monthly Hours Reporting Form

 

TUTOR'S NAME
LEARNER'S NAME

 

 

This report is for

 

Number of Meetings Tutoring Time
Preparation Time Travel Time
       

 

Working toward goals is very important.
Is there anything your learner can do now - as a result of your tutoring - that was not possible before?
Please check any areas that apply.

 

EMPLOYMENT
Has learned interview skills or entered job training.
Got a new job
Has improved skills or status at current job
Other work-related achievements
Comments/Elaboration:

 

HEALTHY LIFE
Yes, I can read medicine directions
Can explain a medical problem to a nurse or doctor.
Can fill out medical forms
Other related achievements
Comments:

 

EDUCATION
Entered a class or a training program
Completed a class or a training program
Practiced for or passed GED
Other related achievements
Comments

 

CHILDREN'S EDUCATION
Read to children
Helped with homework
Talked to teachers/got more involved with school
Other related achievements
Comments

 

CIVICS
Is preparing for or has passed citizenship test
Registered to vote or voted for the first time
Increased participation in community groups
Other related achievements
Comments

 

LIFE SKILLS
Can use the telephone with confidence/Can take or leave messages
Received a driver's license
Can read maps/ menus/ newspapers
Can go shopping independently
Other related achievements
Comments

 

COMPUTER
Learned basic computer skills
Other related achievements
Comments

 

LIBRARY
Got library card/ Checked out books
Other related achievements
Comments

 

STATUS: HAVE YOU OR YOUR LEARNER CHANGED YOUR PHONE NUMBER, EMAIL, OR MAILING ADDRESS?
WHAT IS THE NEW INFORMATION?

 

STORY: DO YOU HAVE A STORY OR ANY COMMENTS TO SHARE?

Thank you for keeping up with this important part of the tutoring experience.
Reporting is essential to accreditation and funding.

 

 

 

 

 

 


Home  •  Teach  •  Learn  •  Volunteer  •  What’s Happening  •  About Literacy  •  Media  •  About Us  •  Photo Gallery
Twitter
facebook