Loudoun County, Virginia
	Family Services
	102 Heritage Way, N.E., Suite 103, Leesburg, VA 20176
	(703)771-5204 Voice (703)737-8895 FAX
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Loudoun County Family Self Sufficiency

Monthly Progress Report

NAME:

REPORT MONTH AND YEAR:

CHECK ALL BOXES THAT DESCRIBE YOUR CURRENT SITUATION FOR THE MONTH:

1. Employed full time by

2. Employed part time by

3. Seeking employment: Name and Phone # of employers Contacted:

A.

B.

C.

D.

4.I attended training/educational class/tutoring/living skills class. Please list the name of Course and Organization providing the instruction. (Employment & Training, JOBS, Public School, Community Mental Health, etc.)

A.

B.

C.

D.

5. I received services through a county or community agency. List name of Agency & Service provided.

A.

B.

C.

D.

6. Some information I would like to share (event that happened this month.)

7. I completed the following Contract of Participation goal or interim goal this month. (Consumer Credit Counseling Appt., 1st Time Homebuyer Workshop, Employment Orientation, etc.)

Email Address: