MONTHLY STUDENT ACTIVITY REPORT
Submit at the end of EACH quarter: Indicate Which quarter you are reporting on:
1st
2nd
3rd
4th
Due: Nov 12
Due: Jan 27
Due: Mar 31
Due: June 13
Fill in all blanks below:
Recently moved? Write your new address
on back of this form.
Attending different school?
(Student’s Full Name)
SCHOOL: ________________________________________________
List any change: ________________________________________________________________________________
It is NOT necessary to resubmit the previous quarters activities, please see example.
If you need additional space, please attach additional sheet.
Assessment and study Log: Assignments and Out of Class Study Time
September
October
November
December
January
February
(OVER)
Enter Amount of Time
March
April
May
June
Total Hours (outside of class hours) spent studying this quarter = ________
Other Activities I have been involved in this quarter are:___________________________________________
_______________________________________________________________________________________
I need assistance with the following: _________________________________________________________
_______________________________________________________________________________________
Signature: ________________________________ Signature: ________________________________
(Student)
(Parent, Teacher, Counselor, etc.)
Please turn in by the specified due date listed on the front side of this form via ONE of these methods:
1.
2.
3.
4.
Mail to Upward Bound, 204 Nelson Hall, UW-Stevens Point, Stevens Point, WI 54481
Fax to Upward Bound at 715-346-3120
Email (scan and send electronically) to Judy Young at jyoung@uwsp.edu
Hand directly to an Upward Bound staff member or paraprofessional