HUGHES: 2024-2025 Work-based Learning Hours Reporting Form
Students should complete this form to keep track of work-based learning hours.  Please complete all items below to record your hours for approval.
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School *
Last Name *
First Name *
Student ID # *
Date of Experience
-if this experience covered multiple days in the same week, please put the date for Monday of that week
-if this experience covered multiple days in the same month, please put the date for the first day of the month
 *
MM
/
DD
/
YYYY
Was this experience for more than one day in the same week or month? *
Summary of Experience (please describe the activity) *
Please give the name of the company where you worked. *
Please give the name of the contact person at the company where you worked. *
Number of Hours - only list the number - do not put any words *
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