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PO Box 580 Okmulgee, Oklahoma 74447 Jenks :

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PO Box 580
Okmulgee, Oklahoma 74447
Okmulgee : 918-732-7985 Fax: 918-758-1477
Jenks : 918-549-2484
Fax: 918-298-4197
WEEKLY TIME REPORT
Participant Name:
Reporting Period
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Travel
Time
Weekly
Total
TANF Use only
Employment
Address:
__________
_______
_________________
Work Experience
Address:
__________
_______
_________________
Other:
Comments:
Certification of hours: I hereby certify that this is a true & correct record of participants attendance for the Report Period indicated.
Supervisor Signature:
Date Signed: / /20____
Contact Number: ( ) -
Certification of hours: I hereby certify that this is a true & correct record of participants attendance for the Report Period indicated.
Supervisor Signature:
Date Signed: / /20____
Contact Number: ( ) -
Participant Certification: I hereby certify that this is a true & correct record of my attendance for the Report Period indicated.
Participant Signature:
Date Signed: / /20____
Contact Number: ( ) -
TANF PROGRAM OFFICE USE ONLY
Total Weekly Hours:
Total Monthly Hours:
Weekly WP Code
Weekly WP Code
1:
2:
3:
4:
5:
1:
2:
3:
4:
5:
Incentive Amount issued:
$
Incentive Amount issued:
$
Wetumka: 405-452-1109
Fax: 918-758-1477
PO Box 580
Okmulgee, Oklahoma 74447
Okmulgee : 918-732-7985 Fax: 918-758-1477
Jenks: 918-549-2484
Fax: 918-298-4197
WEEKLY TIME REPORT
Education & Training Activities
Participant Name:
School Name:
Please circle: College Vocational Education GED
Reporting Period
Monday
Tuesday
Wed
Thursday
Friday
Saturday
Sunday
Travel
Time
Weekly
Total
TANF Use only
Instructor Signature:
Instructor Signature:
Instructor Signature:
Instructor Signature:
Instructor Signature:
Instructor Signature:
Instructor Signature:
Instructor Signature:
Absences:
School Holiday
Class Cancelled
Doctor Appointment
Unexcused
Study Time
TANF USE ONLY
Comments:
Participant Certification: I hereby certify that this is a true & correct record of my attendance for the Report Period indicated.
Participant Signature:
Date Signed: / /20_____
Contact Number: ( ) -
TANF PROGRAM OFFICE USE ONLY
Total Weekly Hours:
Total Monthly Hours:
Weekly WP Code
Weekly WP Code
1:
2:
3:
4:
5:
1:
2:
3:
4:
5:
Incentive Amount issued:
$
Incentive Amount issued:
$
Wetumka: 405-452-1109
Fax: 918-758-1477
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PO Box 580 Okmulgee, Oklahoma 74447 Jenks :

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Completed 1 February 2022

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