LSSD Extended Learning Program

Verification Report for 2007-2008

Activity ________________________________ Teacher ______________________

Grade level of student(s) ____________

I verify that I have completed __________hours on this activity beyond LSSD contract time and that an accountability form for completed work, student sign-in form, student/parent survey and program evaluation forms are attached to this report.

ELP Teacher’s signature _________________________________Date____________

This is to document that this teacher has completed the above activity in an acceptable manner according to the LSSD Extended Learning Program guidelines for 2007-2008.

Principal’s Signature ____________________________________Date_____________

Return the documentation below to Stan Blades at central office to process for payment:

1. Accountability Form
2. Student sign-in Form(s)
3. Student/Parent Surveys
4. Program Evaluation Form