Participant Tracking Form

---

Overview

Instructions
Participant Information
Project Information
Project Tracking

---

Sheet 1: Instructions

Public Lands Corps Tracking Form

Please complete requested information on all three tabs of this spreadsheet.

In the "Participant Information" tab, please provide information for each Public Lands Corps participant you’ve engaged.

In the "Project Information" tab, please provide information on each of the projects in which you’ve engaged Public Lands Corps participants.

In the "Project Tracking" tab, please track the number of hours each participant has worked on each of the projects tracked.

Tracking sheet should be completed quarterly and sent via secure email to: [email protected]

Incomplete provision of the information requested in this form may result in in participants not being able to gain the privileges offered by completion of the program.

Burden Statement

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-New. The time required to complete this information collection is estimated to average six hours, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The U.S. Department of Agriculture (USDA) and U.S. Department of the Interior prohibit discrimination in all programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA and USDI are equal opportunity providers and employers.

Privacy Act Statement

The data collected for the PLC spreadsheet would fall under the Forest Service’ End-User Computer Environment (or EUCE) information system.  EUCE is an accredited system with a corresponding, signed and approved Privacy Impact Assessment (PIA).  The EUCE PIA is required by OMB Memorandum 03-22, which provides guidance for implementing the privacy provisions of the E-Government Act of 2002. The password protected file will be stored on a fully encrypted laptop, only being accessed by authorized Forest Service employees working as part of the administration of the Volunteer and Service program in the Forest Service’s Washington Office.

---

Sheet 2: Participant Information

PUBLIC LANDS CORPS PARTICIPANT INFORMATION FORM
Partner:				Submission Date:				Name, Title, Contact Information:
Participant
Last Name	First Name	Middle Initial	Permanent Residence Zip code	Email Address	Date of Birth MM/DD/YYYY	Gender	Ethnicity	Race - 1	Race - 2	Education Level Completed	College/University Name	Major	Military/Veteran Status	Career Goals	Skills and abilities	Total Hours Worked	Full Name
									Black or African American
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00
																0.00

---

Sheet 3: Project Information

PUBLIC LANDS CORPS PROJECT INFORMATION FORM
Partner
Partner Name	Agreement Number	Deputy Area/Office	FS Unit (Location)	Start Date MM/DD/YYYY	End Date MM/DD/YYYY	Project Title	FS Supervisor Last Name	FS Supervisor First Name	FS Supervisor Email Address	Project Total Hours	Narrrative/Comments

---

Sheet 4: Project Tracking

PUBLIC LANDS CORPS PROJECT TRACKING FORM
Participant	Project
First, Last Name	Position Type	Project Title	Project Description	Type of Work	Project Hours Worked	Certificate Status	Certificate Date of Completion MM/DD/YYYY	Narrrative/Comments