CAREER PATHWAYS INITIATIVE
Participant Time Card/Attendance Report
Transportation and Child Care Assistance
Section I: Participant and Work Activity Information
Participants Name:
Name of Worksite:
Beginning Date:
Supervisor’s Name:
Ending Date:
Contact Number:
Hours per day:
Days per week:
Job Activity Description:
Section II: Work Activity Schedule and Time Card
Please complete for each day participant is scheduled to work or participate.
Work Activity Date
Actual Hours Participated
Work Activity Date
Actual Hours Participated
Supervisors Signature:
Date:
Section III: Class Attendance and Performance Evaluation
Report Date:
Class Title:
Student has satisfactory attendance and participation in the preceding 30 days.
Instructor Signature:
Report Date:
Class Title:
Student has satisfactory attendance and participation in the preceding 30 days.
Instructor Signature:
Report Date:
Class Title:
Student has satisfactory attendance and participation in the preceding 30 days.
Instructor Signature:
Report Date:
Class Title:
Student has satisfactory attendance and participation in the preceding 30 days.
Instructor Signature:
Report Date:
Class Title:
Student has satisfactory attendance and participation in the preceding 30 days.
Instructor Signature:
Participant’s Signature:
Date:
Section IV: To Be Completed by Career Pathways Staff
Comments:
Date Submitted to CP:
CP Staff Signature: