TIME AND ACTIVITY REPORTING FORM

College Cost Reduction and Access Act
Asian American Native American Pacific Islander-Serving Institution Grant Project

This form should be completed and submitted to the Project Director, Mae Lee (x8973, MCC-21), within 7 days after the end of the month. It serves to confirm payroll fiscal records for all grant-supported activities.

ACADEMIC YEAR: 				   MONTH: 						

Last Name: 	         	                       First Name:     	  		
Position Title in Relation to Grant:  	Instructor of Learning Community Class			 
WEEK / DATES	MAIN ACTIVITIES	Hours Per Week	
Week 1 of Month (M-F)
Dates: 

		
Week 2 of Month (M-F)
Dates:

		
Week 3 of Month (M-F)
Dates:	

		
Week 4 of Month (M-F)
Dates:

		
Week 5 of Month (M-F)
Dates	

		

I certify that the information above is correct.

Employee Signature			Date		Signature: Grant Curriculum Coordinator	Date

Signature: Employee’s Supervisor	Date		Signature: Grant Project Director		Date