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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