SAMPLE
Cooperative Education--Monthly Time Card

___________________________________	________________________________________
School District					Name of School

___________________________________	________________________________________
School Address				Name of Teacher/Coordinator

___________________________________  	________________________________________
Telephone of Teacher/Coordinator		E-mail of Teacher/Coordinator

___________________________________	________________________________________
Student Name					Social Security Number

___________________________________	________________________________________
Student Date of Birth				Student Age

___________________________________	________________________________________
OJT Release Periods from School		Job Placement-Company Name

___________________________________	________________________________________
Company Address				Supervisor Name

MONTH: ____________________
Day	Arrive (Time)	Leave (Time)	Hours Worked	
MONDAY				
TUESDAY				
WEDNESDAYY				
THURSDAY				
FRIDAY				
SATURDAY				
SUNDAY				
MONDAY				
TUESDAY				
WEDNESDAY				
THURSDAY				
FRIDAY				
SATURDAY				
SUNDAY				
MONDAY				
TUESDAY				
WEDNESDAY				
THURSDAY				
FRIDAY				
SATURDAY				
SUNDAY				
MONDAY				
TUESDAY				
WEDNESDAY				
THURSDAY				
FRIDAY				
SATURDAY				
SUNDAY				

Signature of Supervisor__________________________________	    Date _________________

Signature of Student ____________________________________	    Date_________________

**Attach one check stub for pay period to this time card for official audit**