Loudoun County, Virginia
	Family Services
	102 Heritage Way, N.E., Suite 103, Leesburg, VA 20176
	(703)777-0353 V/TTY (703)737-8895 FAX
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Loudoun County Welfare to Work Voucher

Monthly Progress Report

REPORT MONTH AND YEAR:

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

1. Employed full time by Hours per week:

2. Employed part time by Hours per week:

3. Seeking employment: List your Contacts including Company Name, Contact Name and Phone Number: (Hit the 'Enter' key after each set of Company, Contact and Phone number to start a new line.)

4.I attended education,training, tutoring or counseling programs. List the Course Name and Organization providing the instruction. (Career Support Services, Public School, Mental Health Provider, NOVA, Financial Counselor, etc.)

A. Hours per month:

B. Hours per month:

C. Hours per month:

D. Hours per month:

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.)

Email Address:

Name:

YOU MUST WORK OR ATTEND TRAINING OR OTHER PROGRAMS FOR 35 HOURS EVERY WEEK.