Continue to pages 3 &4 for additional info for your BTH campus contact. Bridge To Hope FIRST TO WORK PARTICIPATION VERIFICATION To complete the form (click & type in the grey area.) Note: Have your Case Manager Complete this Page verifying work hours required. Then return the completed form to your BTH campus coordinator. Student Name: to Work Case Manager Contact Information: Name: Unit & Location: Phone #: Email: Fax: Total number of hours of activity” required: “work No. months of TANF eligibility remaining: = End Date: mm/yy Student is: (Please check 1) Utilizing Voc Ed/Training (VET) as Hours” OR “Core Utilizing Skills Training” as “Job “Non-Core” Voc Other (Please specify) ********************************** Cash Assistance: Processing Center & Contact Info for “Changes” Team (To inform FTW of BTH earnings) “exempt” Unit Name & Location:
Continue to pages 3 &4 for additional info for your BTH campus contact. Bridge To Hope FIRST TO WORK PARTICIPATION VERIFICATION Note: To complete the form (click & type in the grey area.) Have your Case Manager Complete this Page verifying work hours required. Then return the completed form to your BTH campus coordinator. Student Name: to Work Case Manager Contact Information: Name: Unit & Location: Phone #: Email: Fax: Total number of hours of “work activity” required: No. months of TANF eligibility remaining: = End Date: mm/yy Student is: (Please check 1) Utilizing Voc Ed/Training (VET) as “Core Hours” OR Utilizing “Job Skills Training” as “Non-Core” Voc Other (Please specify) ********************************** Cash Assistance: Processing Center & Contact Info for “Changes” Team (To inform FTW of BTH “exempt” earnings) Unit Name & Location:
BTH_NewParticipant_Sep2015.docx