Form Sna-1046a - Monthly Work Activity Report Page 3
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3ARIZONA DEPARTMENT OF ECONOMIC SECURITY
SNA-1046A FORFF (12-17)
Page 3 of 3
Workforce Development Administration
Supplemental Nutrition Assistance Employment and Training (SNA E&T) Program
MONTHLY WORK ACTIVITY REPORT
PARTICIPANT NAME (Last, First, M.I.)
JAS ID NUMBER
DUE ON:
Activity
Sat
Sun
Mon
Tues
Wed
Thurs
Fri
Weekly Totals
WEEK 5
SITE MONITOR’S NAME, SIGNATURE, LOCATION & PHONE NO.
DATE:
Employment
Job Readiness
Education/Training
Homework
TAA
WIOA
Work Experience
Community Service
Submit Application/Resume
Interview
Follow-Up Call/Email
(Check all that apply):
Job Search
Other:
GRAND TOTAL
Did you incur a Transportation Expense?
Yes
No
SNA E&T PARTICIPANT SIGNATURE
DATE
SNA E&T SPECIALIST APPROVAL
DATE
COMMENTS:
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the
Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in
admissions, programs, services, activities or employment based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. The Department must make a reasonable
accommodation to allow a person with a disability to take part in a program, service or activity. Auxiliary aids and services are available upon request to individuals with disabilities. For example,
this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the
Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you
will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in
alternative format or for further information about this policy, contact your local office manager; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request.
• Disponible en español en línea o en la oficina local.
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