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INDIANA DEPARTMENT OF TRANSPORTATION <br />ECONOMIC OPPORTUNITY DIVISION <br />100 North Senate Avenue <br />Room N750 <br />Indianapolis, Indiana 46204-2216 <br />Telephone: (317) 233-2412 Fax: (317) 233-0891 <br />4tBlhMNm LmAQt�22�3,lqrn <br />MONTHLY OJT TRAINEE HOURS REPORT <br />(Due no later than 2011 of the following month) <br />1. Contractor Name; 1 2. Trainee Name: <br />3. Sex: <br />E] Male [] Female <br />Date <br />4. Racial/Ethnic Identification (Check One or More): <br />n American Indian or Alaska Native DAsian OBlack or African American <br />El Hispanic or Latino El Native Hawaiian or Pacific Islander E]White <br />Project # INDOT Hours Non-INDOT <br />Hours <br />Total Hours This Reporting Period: <br />Total Combined Training Hours This Period, <br />Total Combined Training Hours For Current Year: <br />PREPARED BY: Signature and Title of Contractor's Representative <br />Date: <br />