Wtw 2 - Welfare To Work Plan Activity Assignment Page 2
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4ASSIGNMENT AND SERVICES
ACTIVITY, LOCATION, SCHEDULE, AND HOURS
ACTIVITY:
1.
BEGINS:
EXPECTED TO END:
SCHEDULE:
HOURS PER WEEK:
LOCATION:
ACTIVITY:
2.
BEGINS:
EXPECTED TO END:
SCHEDULE:
HOURS PER WEEK:
LOCATION:
ACTIVITY:
3.
EXPECTED TO END:
SCHEDULE:
BEGINS:
LOCATION:
HOURS PER WEEK:
ACTIVITY:
4.
EXPECTED TO END:
SCHEDULE:
BEGINS:
LOCATION:
HOURS PER WEEK:
■ ■
The county will send me the location and schedule for my ______________________ activity by ________________.
ACTIVITY
DATE
■ ■
I will go to _________________________ on/by____________ to get my___________________________ location
DATE
ACTIVITY
LOCATION
and/or schedule.
■ ■
I will give my Welfare-to-Work worker a copy of my ____________________________________________________
ACTIVITY
schedule by____________. I will tell my Welfare-to-Work worker if any changes are made and give my Welfare-to-
DATE
Work worker a copy of the changes if required.
■ ■
I understand that if I do not go to _______________________________/ ______________________________
ACTIVITY
ACTIVITY
as required by the county or make satisfactory progress in these activities, the county will decide why, and I may have
to go to different activities. I understand that I must give proof of satisfactory progress in these activities to my
Welfare-to-Work worker by the date(s) listed below.
Activity:_______________________________________________________ Date Proof is Due:________________
Activity:_______________________________________________________ Date Proof is Due:________________
Activity:_______________________________________________________ Date Proof is Due:________________
Activity:_______________________________________________________ Date Proof is Due:________________
■ ■
Additional Comments:
WTW 2 (12/12) REQUIRED FORM - SUBSTITUTES PERMITTED
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