NAME:______________________________________________________________________________
ADDRESS: __________________________________________________________________________
NGH #:___________________
YEAR:________
MEETING DATE & TOPIC
# of HOURS
_____________________________________________________________________________________
JANUARY
_____________________________________________________________________
/ ______________
FEBRUARY
_____________________________________________________________________
/ ______________
MARCH
___________________________________________________
__________________ / ______________
APRIL
_____________________________________________________________________
/ ______________
MAY
_____________________________________________________________________
/ ______________
JUNE
_____________________________________________________________________
/ ______________
JULY
_____________________________________________________________________
/ ______________
AUGUST
_____________________________________________________________________
/ ______________
SEPTEMBER
_____________________________________________________________________
/ ______________
OCTOBER
_____________________________________________________________________
/ ______________
NOVEMBER
_____________________________________________________________________
/ ______________
DECEMBER
_____________________________________________________________________
/ ______________
DESCRIPTION OF OTHER HOURS ACCUMULATED: _________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________