Internship and Externship Hours and Wage Time Log

Tracks student worksite hours, wages, and supervisor verification toward work-based learning (WBL) hour requirements for credit and certification.

Student and Program Information

• Student ID
  Enter the school-assigned student identifier. Do not enter SSN or other unnecessary PII.
• Student Name
  Enter the student's full name as used by the program.
• Program Type
• School or Program Name
• Worksite / Placement Site

Log Entry Details

• Work Date
• Start Time
• End Time
• Unpaid Break Minutes
  Enter unpaid break time, if any.
• Total Hours Worked
• Work Performed / Learning Activities
  Briefly describe the tasks, projects, or learning activities completed during this session.

Wage and Compensation

• Is this placement paid?
• Hourly Pay Rate
  Enter the hourly wage only if the placement is paid.
• Compensation Type
• Wage Notes
  Add any reporting notes about pay structure or wage adjustments.

Supervisor Verification

• Supervisor Name
• Supervisor Title
• Supervisor Email
  Optional contact field for verification follow-up.
• Supervisor Signature
• Verified Hours
  Confirm the total hours approved for this session.

Student Attestation and Submission

• I certify that this log is accurate to the best of my knowledge.
• I understand this information will be used to track WBL hours, credit, and certification records.
• Additional Notes
  Optional notes for the program coordinator. Do not include sensitive personal information.