Attendance Verification Form

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Attendance Verification Form
Pursuant to Federal Deficit Reduction Act (DRA)
Student’s Name:
00__ __ __ __ __ __ __
Program ID Number:
________________________________________________________
Education/Training Activity Name: ________________________________________________
Education/Training Activity Start Date: ____/____/____ End Date: ____/____/____
Instructions for Education/Training Provider: Please verify this student’s actual attendance for the above named activity by writing in the number
of hours of attendance for scheduled hours listed below including supervised in-class study time.
Bi-Weekly Attendance
Mon Hours
Tues Hours
Weds Hours
Thurs Hours
Fri Hours
Sat Hours
Sun Hours
Record
Scheduled
Attended
Scheduled
Attended
Scheduled
Attended
Scheduled
Attended
Scheduled
Attended
Scheduled
Attended
Scheduled
Attended
Week 1:
From: ____/____
To: ____/____
Week 2:
From: ____/____
To: ____/____
Please Indicate:
Is “homework” assigned in this course?
Yes
No
Please complete with the name, signature and date of person verifying attendance.
Print Name
Signature
Date
Return completed form to the student or mail/Fax to:
_______________________________
Comments:
_______________________________
_______________________________
JFES-13
2013

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