Need Statement for a Mentoring Program for a Grant

							          Mentoring and Student Assistance Initiatives
            MONTHLY ATTENDANCE REPORT

  District/Program Name:

       Project Name:

 Project (Grant) Number:

      Monthly Report:                         January                       Year of Report:
Instructions: For each center within your program, provide the indicated information on operation and student
attendance for the specified month for the mentoring program(s). Only provide information for the month
indicated.

IMPORTANT: All attendance and operational records supporting the reported values must be maintained and
made available upon request of the FDOE
                                                                                        Student Attendance
                                                  Center Operation                    During Indicated Month
                                             During Indicated Month Only                       Only
                               Indicate Days of
                                  Operation                                 Total       Total
                              (Use "X" to Mark                 Total Days Number of   Number of    Average
                                     Day)         Weeks of         of     Mentoring   Students       Daily
       Center Name            M T W R F S Operation Operation               Hours      Enrolled   Attendance
                                                COMMENTS




                                STATEMENT OF DATA VALIDATION
I hereby confirm that the data reported on this 'Monthly Report' submission to the Florida Department of
Education has been verified and validated as accurately reflecting the operation of this Mentoring Program
(Project Number: <ProgramNumberBlankAbove>) during the January of <YearBlankAbove>.


_____________________            ___________________________
Signature of Program/Grant       Printed Name of Program/Grant                       Date of Verification
Administrator                    Administrator