Form 08TW013E (TW-13) revised 3-1-2010 may continue on next page, page 3 of 4
Facility name Date
Participant’s name Case number
Scheduled hours per week Performance month Activity
Part IV: Attendance. All actual hours of participation must be recorded. Participant
makes appropriate daily entries, which document actual hours in attendance. Do not
include lunch hours and travel time. For persons in Job Search, travel between job
interviews and job applications is part of the activity and can be counted. Participant
initials daily entries in appropriate block(s).
OKDHS use only: This plan of study is approved for homework or study hours.
2
Codes: AE = Absent; H = Holiday; W = Weekend/regular day off
Date Time
in
Time
out
Time
in
Time
out
Time
in
Time
out
Total
hours
Parti-
cipant
initials
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
I certify the record of my hours is true and correct.
Signature of participant Phone number Date
Note: Submit pages 3 and 4 to the local human services center no later than the fifth of
the next month. Participant allowances will not be paid in excess of $13.00 per day.
2
Statement from instructor, professor, advisor, or class syllabus MUST BE DOCUMENTED in case notes to
allow homework or study hours. Worker enters number of allowed homework or study hours for the plan of study.
______________________/_______
Oklahoma City Community College Career Transitions
