2010-2011 Mayor Daley’s Book Club - Middle School

Monthly Report and Timesheet

School______Mail Run ______

Meeting Date:______Meeting Time: ______

Title of the Book:______

Student Name (students must sign in each month) / Grade
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Facilitator #1 Name:______Date______

Facilitator Signature:______Number of Hours____

Employee ID (found on check stub): ______Home/Cell Number: ______

Facilitator #2 Name:______Date______

Facilitator Signature:______Number of Hours____

Employee ID (found on check stub): ______Home/Cell Number: ______

Principal Signature:______Date______

Please check below:

_____ Included in this fax is a signed packing slip for books received

_____ A signed packing slip of received books has been sent via mail run

Please send a copy of both documents to: K.C. Boyd, Wendell Phillips Academy High School, 244 East Pershing Road, Chicago, IL Area 28, GSR 40 or fax this form along with a copy of the packing slip to

K.C. Boyd at 773-535-0316 or If you have any questions regarding the MDBC Middle School program, please contact K.C. Boyd at or 773-535-1603 ext. 50315