Weekly Report Checklist

Please take a few minutes each day or two to complete this checklist, indicating which activities you did, on which days, and for how long. This report will help you self-monitor and help us collect some of the data we need. You will submit this report to your liaison.

E.g.

ACTIVITY
M
TU
W
TH
F
Interviewed student on goals
 
20 min.
15 min.
 
 
Worked on setting short-term goal
15 min.
 
15 min.
 
 
Explained self-consequating
 
 
 
20 min.
 
 
 
 
 
 
 

 
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