Attendance Log

Your Program Name
Public Burden Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number (OMB
0985-0039). Public reporting burden for this collection of information averages and estimate of .50 hours per response, including time for gathering, maintaining the data, completing, and
reviewing the collection of information. The obligation to respond to this collection is voluntary.

Attendance Log
Instructions to Program Leaders/Coaches/Instructors: Please clearly print the Program Information and the Participant IDs below. Write
participants’ IDs as they appear on their Participant Information Form.
Mark each session that the participant attends with an X
Implementation Site Name:___________________________________
Program Start Date (mm/dd/yyyy)

__ __/__ __/ __ __ __ ___

Program End Date (mm/dd/yyyy)

__ __/__ __/ __ __ __ ___

Participant ID
1
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2.
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2

3

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5

6

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8

9

Session Number*
10
11
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13

14

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16

17

18

19

20

6.
7.
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10
*Adapt this section to include the number of possible sessions. Use additional pages if needed.

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