CSU LA Model: LA Time and Effort report (4.0)
Please complete this time and effort report for each week. Note that in most cases your total hours for the month will be 20 hours - be sure your total hours equal the sum for each quarter. Most questions are required.

You will be submitting at the end of each month and indicating hours for that month. For instance on Sept 30, you would be submitting all your hours for Sept.  Then on Oct 31, you would be submitting your hours for the entire month of October. 

Please use whole numbers - round up when needed. The important piece is that the total hours accurately reflect the time you put in.

The two questions with ** require detail. Lack of detail can delay result in requiring resubmission and could delay your stipend for that period.  


Sign in to Google to save your progress. Learn more
Email *
Name: *
CSU ID: (90XXXXXX) *
Major: *
Year: *
Dates Reporting (indicate the month) *
What were your total hours for the month? (In most cases this should total to 20 hours. This number needs to be the same as the sum for each of the four quarters of the month.
1st quarter of the month hours (in most cases this should total to 5 - please use whole numbers): *
2nd quarter of the month hours (in most cases this should total to 5 - please use whole numbers): *
3rd quarter of the month hours (in most cases this should total to 5 - please use whole numbers): *
4th quarter of the month hours (in most cases this should total to 5 - please use whole numbers): *
Which field/discipline do you LA for? *
What is the course name and number for your LA assignment (Example: MATH 1020) *
I attest that this is a true and accurate report of my time and effort for this reporting period. *
I accept this stipend award. 
** Please reflect/comment on your LA experience for this month. What worked or is working? What was or is a challenge? Are there any examples you can cite where you were able to help students tackle a challenging idea or concept? ... Please be specific on this question and report what you did to support students. *
** Describe what you did in your LA assignment this month. Be specific with activities and the hours spent. For instance: 2 hours facilitating group work in lab; 1 hour meeting with students online, 1 how meeting with the instructor, 1 hour responding to discussion board comments in Moodle. (Note: Failure to provide detail on this question can delay your stipend for this period.) *
Did you meet or interact with students outside of class this month - either through tutoring hours or through an email exchange or phone call, etc? If so, please list the names of the students you interacted with *during the past month*.
CSU LA Program Funders
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms