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School Year: Staff: Email: Parent Email: First Name: Last Name: Week of: To:

Day of Week	Date	Beginning Time	Ending Time	Beginning Time	Ending Time	Total Hrs

Total Weekly Hours

0:00

By checking this box, I , certify that the reported time is correct.

*Student Over 18/Parent/Guardian Signature (Students under 18 cannot sign)

Minimum Time Requirements:

Full time

1.0 FTE

30.00 Hrs/Per Week

**140 Hrs of school work time is required per possible 1.0 credit

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