Don Mayfield--ILAST Participant 80 hour Accounting Form 

Please refer to you Action Plan form for a full explanation of categories--and category limits. Use this form to submit at least 5 hours at a time, even though the hours may be spread over several categories. If your activity addresses more than one category, select additional categories and record hours in each slot. If only one category applies to the activity, leave category 2 and 3 menus on "Select." 

Be sure to keep a personal copy of your hours. 

When you send the form with reflections, send a separate email with your attachments (related documents, graphics), when required, to donmayfi@sdcoe.k12.ca.us. In that email, indicate title of activity in SUBJECT line of your email. Please send the Accounting Form and email with attachments on the same day.

Name:

Email:

Institute #

Category 1

Time Spent

Category 2

Time Spent

Category 3

Time Spent

Describe Activity

Reflection