Tutor Hourly Reporting Form

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1 Start 2 Complete

Please complete this form on the final business day of the month. Please allow 7-10 business days for the payment to process.

Personal Information

1. Name *

2. Phone Number *

3. Email *

Hours Record

4. Please select the month you are entering your hours for: *

January

February

March

April

May

June

July

August

September

October

November

December

5. For Week 1 of selected month, please indicate how many days you worked on site: *

1 Day

2 Days

3 Days

4 Days

5 Days

None

Date Selection (1 Day)

What day during this week did you work?

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (2 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (3 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (4 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fourth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (5 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fourth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fifth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

5a. How many total hours did you work for week 1? *

If you did not work any hours this week, please type "N/A".

6. For Week 2 of selected month, please indicate how many days you worked on site: *

1 Day

2 Days

3 Days

4 Days

5 Days

None

Date Selection (1 Day)

What day during this week did you work?

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (2 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (3 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (4 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fourth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (5 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fourth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fifth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

6a. How many total hours did you work for week 2? *

If you did not work any hours this week, please type "N/A".

7. For Week 3 of selected month, please indicate how many days you worked on site: *

1 Day

2 Days

3 Days

4 Days

5 Days

None

Date Selection (1 Day)

What day during this week did you work?

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (2 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (3 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (4 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fourth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (5 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fourth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fifth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

7a. How many total hours did you work for week 3? *

If you did not work any hours this week, please type "N/A".

8. For Week 4 of selected month, please indicate how many days you worked on site: *

1 Day

2 Days

3 Days

4 Days

5 Days

None

Date Selection (1 Day)

What day during this week did you work?

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (2 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (3 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (4 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fourth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Date Selection (5 Days)

Select the first date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the second date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the third date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fourth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

Select the fifth date you worked:

Month

Day

Year

Select the timeframe you worked:

2-2:30PM

2:30-3PM

3-3:30PM

3:30-4PM

4-4:30PM

4:30-5PM

5-5:30PM

5:30-6PM

8a. How many total hours did you work for week 4? *

If you did not work any hours this week, please type "N/A".

9. Write your total hours for Weeks 1-5: *

10. Did you incur an out of pocket background check expense during this calendar month? *

Yes

If yes, please write the total cost you incurred:

11. During this reported calendar month, did you fuly attend the following (check all that apply): *

Tutoring 101 and Homework Help Online Training (1 hour)

Basic and Intensive Reading Support (1.5 hours)

Basic and Intensive Math Support (1.5 hours)

I have not attended any of these trainings.

Other...

11. During this reported calendar month, did you fuly attend the following (check all that apply): Other...

** Each training's associated quiz must be submitted to verify completion of training module(s).

Leave this field blank

Cleveland State University

Engaged Learning

Tutor Hourly Reporting Form