Literacy Council of Northern Virginia
Basic Literacy Program
Quarterly Reports
April, May, June 2001

Dear Volunteer,

Thank you for taking the time to fill out your report promptly each quarter. We hope that this quarterly report will serve as a useful tool for you and your student to track progress and that it will provide direction for ongoing learning. As we report on student achievements and your tutoring hours to local government and other agencies, we are able to show how effective our volunteers' efforts are in providing literacy instruction to adults in the community.

For assistance please contact the Council at (703) 237-0866.

Volunteer Quarterly Report
April, May, June 2001

Volunteer Information
First Name Last Name

Home Telephone Number Work Telephone Number

Street Address

City State Zip Code

E-mail address

What jurisdiction do you pay taxes in?
Other (please specify)

Placement Advisor

Has tutoring ended?
Yes No

If you are not presently tutoring, are you available to tutor? Yes No

A. Total tutoring hours for this quarter

B. Nontutoring volunteer hours
1. Tutor preparation and travel time
2. Trainer (include preparation & travel time)
3. Placement advisor
4. Workshop registration, in-service help
5. Board member
6. Other hours, please specify
Total nontutoring hours (Add 1 through 6, section B)

C. Workshop, in-service and seminar attendance hours

Student Information
First Name Last Name

Home Telephone Number Work Telephone Number

Street Address

City State Zip Code

Other (please specify)

Total tutoring hours this quarter

Has tutoring ended?
Yes No
If yes, date ended?

Reason tutoring ended

Does the student need another tutor?
Yes No

Current achievement level

Laubach Skill Book
Level Lesson

Challenger Level Lesson

Reading for Today
Level Unit

Other materials used

Please share how tutoring has affected you and/or your student and what skills you and your student are currently working on:

Additional comments (successes, concerns)

Improvement and Achievements (check any that apply)
Self confidence
Got a job
Job performance/advancement
Helped children with homework
Read to children
Registered to vote
Acquired citizenship
Got a library card
Got a driver's license
Read a book
Other (please specify)

Personal Learning Goals Completed This Quarter
Please select any new goals completed this quarter from the Personal Learning Goals List below. Feel free to add other unlisted goals that your student has achieved.

Other goals achieved:

Reading and Writing Skills Completed this Quarter
Please select from the list below any new reading and writing skills completed this quarter. Please feel free to list any other unlisted skills that you student has completed.

Other skills completed:

Student: What have I learned?

Overall Reading Practices
Tutor, please ask your student, "About how much time do you usually spend reading outside of class time? This includes materials you read at home, at work, in your community and during your leisure time." (Please check only one answer.)
Would you say that you usually read:
Not at all
A few minutes a day
About a half-hour a week
About an hour a week
Two or more hours a week
One hour or more a day