Tutor Form

Student
Information

Tutor
Information

Volunteer Tutor Hours

Phone Number:

Tutor:

Student:

Phone Number:

Tutor’s Email Address:

Month:

Year:

Hours Spent With Student:

Total Hours for the Month:

Preparation/Travel Time:

Other RALC Hours:

Meeting Location:

Days/Time:

Student progress (include materials in current use):

Comments, problems or suggestions:

* Student will receive special recognition after 50 hours of instruction.

Please print page 1 for your records, after submitting report.

Please complete this form by the 10th of the month. It will be automatically
emailed to RALC when you click The Submit button below.

TUTOR HOURS FORM