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Series 602. - Instruction Log for a Student Unable to be in School

Adopted: September 1983
Revised: November 2006


TEACHER: Submit this completed form to your principal when instruction is completed.

Student’s Name: ________________________________________________________ Grade: ______________



Hours of Direct



Specific Instructional Activities and Outcomes

Where Instruction Occurred


































































































Signature of Teacher                                                                                        Date                         

Distribution:     Original - student’s cumulative folder                      

Copy – Office of Student Records