Your Experience Counts Service Log
First Name *
Your answer
Last Name *
Your answer
School *
Your answer
District *
NOTE: Districts order has changed, now alphabetical.
Required
Current Teacher *
Your answer
Month of Service *
Required
Total hours *
(NUMBERS ONLY PLEASE--use DECIMALS rounded to nearest 0.25--0.5--0.75 for partial hours)
Your answer
Sessions *
NUMBERS ONLY PLEASE--This is the number of separate days you visited the classroom this month.
Your answer
Please share a challenging experience, memorable student quote (w/ first name*), an example of student success, or something new you learned or tried this month.
(*Student quotes will help us illustrate the impact of our program in a fresh way! Ex: "Ms. D., I get it now!" -Julia / Solano 5th grader.)
Your answer
Name 1 or 2 students who received the greatest benefit from your support this month.
Your answer
Subjects Assisted *
Check all that apply
Required
Mode of Assistance *
Check all that apply
Required
Are you experiencing any difficulties or would you like to speak to a YEC staff person?
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