This form is due no later than the 1st of each month or by the date stated on your current plan.

Please add the option that best fits your activities and progress towards your goal(s).

Job search - Looking for a job, attending interviews, attending workshops, creating/updating resumes and/or cover letters, networking, completing informational interviews, completing and submitting applications, etc.

Unpaid Work Experience - All Unpaid Work Experience activities must be pre-approved by your Career & Family Coordinator before you can begin this activity.  If you have been approved for Unpaid Work Experience, the following information is needed in order to verify hours for your program participation.

Employment - Full or part time employment and/or self-employment.

GED / High School - Attending/participating in an online or in person program to obtain high school diploma or GED.

Post-Secondary Education - Educational program to earn a certificate or degree.

Stabilization - Activities that support personal and family well-being including attending mental and medical appointments for self/children, attending wellness classes/workshops, searching for child-care, attending children’s school/extracurricular activities, substance abuse treatment/relapse prevention, searching for housing, attending court/child protection meetings, etc.

I hereby certify that the hours recorded are true and correctly reported.  I understand that providing false or misleading information to the county to receive public assistance benefits for which I may not be eligible may be considered an intentional program violation.