Student Name   ____________________________
School                ____________________________
Site Trainer        ____________________________
Date of Registration  ________________________

	Name of Module	Date of    Completion	For Credit (CDE,ASC)
1
2
3
4
5
Project Title
6
7
8
9
10
Project Title

                 ____________________________     _______________
                          Signature                    Date
                 ____________________________     _______________
                       Trainer Signature               Date

Checklist:
• I have registered for IET Course with my site trainer.
• I have completed the Pre/Task Assessment Form and given it to my site trainer.
• I have received confirmation of completion of the modules listed above.
• I have completed the Post/Task Assessment Form and given it to my site trainer.
• I have completed the above Student Module Record, signed it, and have obtained my trainer's signature.

  If taking for ASC credit:

• I have completed the ASC Registration and included my payment by _________.
• I have fulfilled all course requirements by _________ and am requesting credit for the _____________ semester.

Last Updated on 9/25/98
By Sandra Turner
Email: turner_s@fortlewis.edu