You must have JavaScript enabled to use this form. 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 * 4. Did you work as a tutor for the Community Learning Center during the 22-23 academic year? * Yes No Hours Record 5. Please select the month you are entering your hours for: * January February March April May June July August September October November December In all hours fields below please only enter numeric values. For example, DO NOT write "1 and a half hours". Instead please write only "1.5" 6. How many total hours did you work for week 1? * If you did not work any hours this week, please type "N/A". 7. How many total hours did you work for week 2? * If you did not work any hours this week, please type "N/A". 8. How many total hours did you work for week 3? * If you did not work any hours this week, please type "N/A". 9. How many total hours did you work for week 4? * If you did not work any hours this week, please type "N/A". 10. How many total hours did you work for week 5? (Only when applicable. e.g. there is a fifth calendar week in the month) * If you did not work any hours this week, please type "N/A". 11. Did you incur an out of pocket background check expense during this calendar month? * Yes No If yes, please write the total cost you incurred: 12. 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... 12. 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). Copy and Paste link in separate browser. Save as a copy and Upload the edited/saved version to question 13. Please fill out the following timesheet template: https://1drv.ms/x/s!AqkOI78Pu8nQmgXY2bavLjv2sajv?e=5jtedW 13. Upload your hourly log for the month reported here: Files must be less than 2 MB.Allowed file types: gif jpg jpeg png txt rtf html pdf doc docx ppt pptx xls xlsx xml zip. Leave this field blank
