Fillable Form 900L.aspx Tutoring Allowance Assistance Log (The Chickasaw Nation)

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Form 900L.aspx Tutoring Allowance Assistance Log (The Chickasaw Nation)

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Form no. 04900L CS-EDU Rev. 5/2018
TUTORING ALLOWANCE ASSISTANCE LOG
STUDENT NAME: _____________________________________________
MONTH: _______________________
Date
Tutored
Time In
Time Out
Subject Tutored
Tutor Comments
I hereby certify that I am the tutor of the abovementioned student and that I am not a relative of the student.
Tutor signature: ______________________________________________________
Date: _________________
Tutor printed name: ___________________________________________________
Tutor mailing address: _________________________________________________
_________________________________________________
Tutor phone number: __________________________________________________
Parent signature: _____________________________________________________
Date: _________________
Total amount paid for
tutoring on this request: $____________________
Bill Anoatubby
Governor
Governor
Education Division
0
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Form 900L.aspx Tutoring Allowance Assistance Log (The Chickasaw Nation)

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Completed 31 January 2021

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