Off-Campus Parent Service Hours Student Name
_________________________________________
Directions: For each entry, note the date, activity, and
number of minutes. (If you check off
“Other Academic Enrichment,” please explain the activity.) Also, write down a short note for yourself
and initial the entry. When this form is
complete, please answer the reflection questions on the back of this form.
* Other Academic Enrichment
may include going to the library, visiting a museum, attending after-school
tutoring program, etc.
** Please do not credit
yourself for more than 10 minutes each day for checking homework.
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Date |
Activity |
Number of Minutes |
Note |
Parent Initials |
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*
Checking homework *
Tutoring *
Other Academic Enrichment: |
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*
Checking homework *
Tutoring *
Other Academic Enrichment: |
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*
Checking homework *
Tutoring *
Other Academic Enrichment: |
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*
Checking homework *
Tutoring *
Other Academic Enrichment: |
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*
Checking homework *
Tutoring *
Other Academic Enrichment: |
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*
Checking homework *
Tutoring *
Other Academic Enrichment: |
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*
Checking homework *
Tutoring *
Other Academic Enrichment: |
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*
Checking homework *
Tutoring *
Other Academic Enrichment: |
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*
Checking homework *
Tutoring *
Other Academic Enrichment: |
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*
Checking homework *
Tutoring *
Other Academic Enrichment: |
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*
Checking homework *
Tutoring *
Other Academic Enrichment: |
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TOTAL MINUTES |
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Date
Form is Submitted to Office: |
||
SHORT REFLECTIONS: Please take the necessary time to answer each
of the questions below to the best of your abilities.
1.
Which
of the activities on this form did you find most rewarding for your child?
2.
What
did you as a parent/guardian learn from your involvement?
3.
What
are some areas of success and/or improvement for your child over this time
period?
4.
What
are some areas of concern for your child over this time period?
5.
How
would you like to enhance your work with your child in the future? Explain any way the school can assist you.
For office Use:
APPROVAL:
____________________________________________ DATE RECEIVED: _________________________