vu Dus ABAWD Work Activity Attendance Form Gragon Depart mas *Please circle in which DHS branch your case is located: Byftn./Hillsboro/Tigard/PC Your Name: (1°/Middle/Last) Your Phone Number: Your Case or Prime Number: [F Prime# _ | E&T Contractor’s Name: PCC Willow Creek Center 241 Edgeway Drive Beaverton 97006 E&q’s Phone Number: 971-722-2555(ABAWD Phone Line) = You must have atotalof ____ hours per week/totaling hours each month. *This form must be completed and turned in to the above address EVERY MONDAY. * You must have a total of. hours each week = Work Hours: Your work hours (for pay, as a volunteer or in exchange for in-kind services or bartering) are reported differently and are not part of this form. You need to use this form to report the hours you do in the activities listed below. = You have reported working hours per week. This will count toward your total weekly hours. * Iwas not able to complete all of the hours for this week because: Total Hours Activity Description: Attendance Week of: SATURDAY Sun. Mon. Tues. Wed. Thurs. FRIDAY (Job readiness Activities (IForJF) | r= = Including Job Search or Training |= Cl Work Experience (EF) C Vocational Education (VF) or Approved Training Program (TF) 1 Adult Basic Education (AF) O Workfare (WF) *Must have worksite provider's signature | | The information | am giving on all pages of this form is true and complete. Client's Signature: Date: Workfare Provider Signature: Date: *See last page of form for additional information on filling out this form.