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Community Violence Intervention Program
Mind Your Mental
Promoting Employment Opportunities for Survivors of Trafficking (PEOST) Initiative
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2025 Placement Site Application
2025 Youth Summer Program Participation Application
Liability Consent Forms
Mindset Kidz’s Program Timesheet
Travel Consent Form
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Home
About Us
Programs
Community Violence Intervention Program
Mind Your Mental
Promoting Employment Opportunities for Survivors of Trafficking (PEOST) Initiative
SMART (Support, Mindset, Attitude, Respect, and Teamwork)
Services
Youth Services
Family Services
Community Violence Intervention Services
Training and Education
Support Us
Forms
2025 Placement Site Application
2025 Youth Summer Program Participation Application
Liability Consent Forms
Mindset Kidz’s Program Timesheet
Travel Consent Form
Links
Gallery
Contact Us
2025 Mindset Kidz's Program Timesheet
Please enable JavaScript in your browser to complete this form.
Participant's Name
*
First
Last
Participant’s Phone Number
*
Participant’s Email Address
*
Placement Site
*
Mentor's Name
*
First
Last
Select work week for hours being recorded. Each work week will require a seperate form to be completed.
*
JUNE 22ND - JUNE 28TH
JUNE 29TH - JULY 5TH
JULY 6TH - JULY 12TH
JULY 13 TH - JULY 19TH
JULY 20TH - JULY 26TH
JULY 27TH - AUGUST 2ND
Enter your hours worked each day during this work week.
If you did not work any hours on a specific day please put "0" (zero),
Sunday
*
Monday
*
Tuesday
*
Wednesday
*
Thursday
*
Friday
*
Saturday
*
TOTAL HOURS WORKED THIS WEEK
*
Participant’s Signature
*
Clear Signature
Mentor’s Signature
*
Clear Signature
Today's Date
*
MM
1
2
3
4
5
6
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9
10
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12
DD
1
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31
YYYY
2026
2025
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1920
Additional Comments
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