oun Sonoma, ‘Maman Services Department SAMPLE SonomaWORKS School Attendance Record Student: Your Name Case #: B222222 ETC Name/Number: P. Smith sRYC Choose one asic Education GED SIP (CORE) ‘Vocational Education & Training ‘asa Second Language OJob Skills Training, SIP (Non Core) Work Study Bother ‘ACommunity Service __CICalWORKs _O Federal Part: Glass Time ‘County Use Only Day of Week oxy w [th] F]S)|su] M|T[W Th FI] S [su | M] T | W]Date Course (eg. "Math 200 12 (3(4/ 51] 6 [7/8 | 9 [40] ia] 42] 43 | 14 | 15 | Daily Rate: CS101A 15, 15 | [45 15. 15 [ANTHRO 1 45, as] [1s 15 45 | ANTRHO 1 Lab U 3 3 | _ ‘CalWORKs Appts._| [J] 2 1 CT I Part B: Work Study (CalWORKS or Federal) or CalWORKS Community Service Part B Hours: UNPAID er (SE O89 ‘Appointment With Employment Services (Angela/Marianne) List dates and reasons absent from Activity: Explain Missed Days Here _ (Provide verification of the absence) aan 1 certify that all reported hours are true and correct. Iancnee omer erased. 0 Sign Date one ‘Student Signature Date aunty aly ETCSignature ‘as Hours THe HoRERorR |] Schoo enrollment atached and aligns with reported hours ih: temnnenelonevoTne | | Students participating in scheduled classes and waking actor prowess @ AllowabeSupervisedomework | | alowable Class Hours= Allowable Supervised Homework Hours= ourstatBecy Origins SonomaWORKS; Goldenrod: Stes Sonoma county