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?rt'_cipant Crane: e.U11tLo l hitch Soc. Sec. #: 539-g8~ ROq
unit of Service: Yogt Cruf,rlCC? Start Date END ATE:
: (-18(o Review Date: 71k,
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Service er Contact Person & Phone enc address
Northwest
Sere ervices C?urc.l tpa,,(-LUc..Qa/1`j 33?-5571002 Lawrence Stream
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i Activity Action Cooperating Aaenc Weekly Schedule
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p :•1ork3hops NSC
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her Actions R aired ecial Conditions Su rtive Services Provided
Failure to attend workshops and appointments can result in loss of hours or
work time.
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aE.1??CE ACFZT +L^ivP - - PACE DIO -`-
OBJ & OUTCGIES BY COrfi'E^_ENCi .:GORY
CC?C ETA?C}' CATEGORY 0&TECTPIF'S GPIDI AC UAL OU"PCCr•TE
Work Maturity Skills Obtain satisfactory (5)
rating on all work maturit;.
skills,
Occupational Skills Become proficient at all
tasks on job, description.
Pre-r7ar1oyment Skills Complete all assig m:ents
as requested.
Participate and complete
job search assignments.
Educational C x L1&MY ,
Attached: 'Job Des. _ Memo of Agreement - OTT Contract - School Curriculum
Participant Personnel Policies VEP Curriculum
Other (specify) Handbook
I certify that I have participated in the development of the above Service Agreement
and understand its conditions and agree to comply with the content and objectives.
Further, I understand that failure to comply may terminate this Agreement. I have
received a copy fo the forms checked above.
Northwest Services Council Pw -Foufx..A Lk JCS ?C2X Sbf\ Coun`4a
Private Industry Council h4 , Sr,h?-r.A }. of'j ublicl?orKS
Organization oort - P - -