Sandhills Community College WBL FORM 3
WORK-BASED LEARNING (CO-OP) ACTIVITY REPORT
Student Name: Program:
Semester:
Work Start Date:
example
MON
TUE
WED
THUR
FRI
SAT
SUN
Dates
8/18/14
Time
1-4 pm
Total
hours
3
Row Total
I verify this is a true and accurate account of hours worked.
Student Signature: _________________________________________ Date: _________________
Supervisor Signature: _______________________________________ Date: _________________
If the student’s work hours will not begin until after the semester census date, a one-hour orientation
may be substituted to confirm student activity.
Orientation Date:
Student Signature: _________________________________________ Date: _________________
Faculty Signature: _________________________________________ Date: _________________
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit