SAMPLE 
Cooperative Education--Weekly Time Card

Public School District:		
Name of Teacher/Coordinator:		
Phone Number:		
E-mail of Teacher/Coordinator:		
Name of School:		
Address:		
City, State, and Zip:		
		
Name of Student:		
OJT Release Periods from School:		
Social Security No:		
Job Placement:       		
Name of Company:		
Address of Company:		
City, State, and Zip:		
Supervisor's 		
Name:		
Title:		
Student's Signature:		
Date of Birth:		
Age of Student:		

WEEK of ________ to __________
Day	Arrive	Leave	Hours Worked	
MONDAY 

TUESDAY

WEDNESDAY 

THURSDAY 

FRIDAY 

SATURDAY 

SUNDAY 

Signature of Supervisor: ____________________________	Date: __________________
Signature of Student: _______________________________	Date: __________________