County of Riverside Employment Services
School Attendance Report
Worker Name:
Worker ID:
Worker Phone Number:
Case Name:
Case Number:
School Name:
School Address:
School Phone Number:
Student’s Name: Student ID:
Attendance Report Time Frame From date:
To date:
Please check one of the following and attach appropriate documentation:
Student class schedule attached. Hours of participation correspond with the days classes are scheduled.
Student’s attendance is listed below:
Date
Total Hours
Total Hours
Absent
Absence Reason
County Use Only
T
otal Hours
I certify the foregoing to be a correct account of classroom and training hours.
School Representative Signature
Date
School Representative Printed Name
Phone Number
COUNTY USE ONLY
COMMENT:
Customer’s total actual hours of attendance: __________ for the month of ______ and year __________.
WTW Worker Printed Name
Phone Number
Date
DPSS 3953 (REV. 6/19) WTW School Attendance Report
Riverside City College
4800 Magnolia Ave Riverside, CA 92506
951-222-8648