Form Test

Volunteer Information (Always complete this section.)

*Last Name *First Name Middle Initial *E-Mail Address

 

Please fill out if changed:

Home Phone Work Phone Ext. Cell Address City State ZIP Code

Volunteer Hours (Always complete this section with all of your hours for this quarter even if 0.)

Total tutoring hours for this quarter

Tutor preparation and travel time

Trainer (training time including preparation and travel time)

Student Interviewer/Assessment Specialist (include preparation & travel time)

Others hours (workshop registrar, special events, etc.)

Please specify roles for other hours

Student Information

*Last Name *First Name

If your student’s contact information or address has changed, please inform tutoring@lcnv.org

Tutoring Model (Check all that apply):

One-to-one tutoring
Two LCNV tutors team-teaching the same student
Small group tutoring (2 to 4 learners)
Tutoring to support an LCNV classroom

Tutoring Continuation or Termination:

*Has tutoring ended ? Yes No

End of Match (Fill out this section only if tutoring ended. Otherwise leave blank and go to next page.)

Date match ended:

Who ended the tutoring? Student Tutor Other

What are the primary reasons for termination: (Choose all that apply under student or tutor)

  Student-related Reasons   Tutor-related Reasons
Finished goals Completed commitment
Entered another program Schedule conflict
Tested out Health reasons
Schedule conflict with job Moved
Schedule conflict with family No place to meet
Health reasons Student motivation or attendance
Moved Incompatible
No place to meet Transportation
Inaccessible DK / other
Incompatible    
Transportation    
DK / other    
Did the student achieve one or more goals during this match? Yes No

Where will the student continue his/her education? (Only Answer if match-ended, mark all that apply)

Another LCNV program (Which program?)
Another agency’s program (Which program?)
Student will not continue education at this time  
Don’t know  

*Book Level/Homework Hours At End Of Quarter

Laubach Way to English Level Survival English/Taking Off Literacy Workbook Level
Life Prints Level Standout Grammar Level
Side by Side Level Oxford Picture Dictionary Level
Side by Side Plus Level None of the above  
Other materials used:(Write in)
*Homework Hours At End of This Quarter

ACHIEVEMENT OF PERSONAL LEARNING GOALS

Check off the most appropriate goal categories for the achievements your student made this quarter. (Check all that apply). Once you check a goal, a comments box will appear. Please feel free to write an explanation in the box.

Employment Goals
Improved job skills this quarter
Started new employment this quarter
Retained employment this quarter
Got a promotion or a better job this quarter

Comments

Citizenship Goals
Achieved citizenship skills this quarter
Passed citizenship test this quarter
Became a citizen this quarter
Registered to vote or voted this quarter

Comments

Specialized Training Goals
Received other education or training this quarter
Improved technology skills this quarter
Obtained drivers license this quarter

Comments

Health, Wellness, and Lifestyle Goals
Improved communication or literacy in these areas this quarter
Improved ability to navigate systems in these areas this quarter

Comments

Financial / Consumer Goals
Improved communication or literacy in these areas this quarter
Improved ability to navigate systems in these areas this quarter

Comments

Strengthened-the-Family Goals
Improved communication or literacy in these areas this quarter
Improved ability to navigate systems in these areas this quarter

Comments

Children’s Educational Goals
Improved involvement in children’s education at home this quarter
Improved ability to navigate school system this quarter

Comments

Community Involvement
Improved communication or literacy in these areas this quarter
Improved ability to navigate systems in these areas this quarter
Engaged in community activities this quarter

Comments

Personal/ Intangible Goals
My student experienced intangible improvements that may be connected to improved English this quarter
Improved communication or literacy in these areas this quarter

Comments

STUDENT ATTENDANCE

Number of tutoring sessions student cancelled this quarter:

NOTES

Use this section to describe what you are working on with your student or to relay any anecdotes you wish to share. (Please do not use this section to ask questions of staff; instead use the contact information below).

CONTACT INFORMATION FOR CURRENT NEEDS

  • If your student needs another tutor or you need another student, please contact your PA or tutoring@lcnv.org.
  • To discuss other volunteer opportunities contact volunteers@lcnv.org.
  • To order books or a library book, contact info@lcnv.org.
  • To discuss a problem or question that you have already discussed with your PA, contact basiclit@lcnv.org.
  • To ask the part-time volunteer librarian a question, contact library@lcnv.org.
  • To see the library collection,click here

THANK YOU FOR YOUR HELP!

If your report is finished, please click the "Submit your report" button.