Skip to content
OJT Participant Monthly Contact Form
This form is completed each month to document your training experience and progress.
OJT Participant Monthly Contact Form New
Newsletter
First Name
Last Name
Status Changes: (Select all that apply)
I have made NO changes
Address
Telephone Number
Email Address
New Address
City
State
Zip
Telephone Number
Email Address
Which best describes your current situation?
I am currently attending training as outlined in my Employment Plan.
I have completed training.
I am no longer participating in the OJT and currently job searching.
Are you attending all required work hours and training activities for your Training Plan?
Yes
No
Please tell us what has changed so we can follow up with support.
Are you on track to complete your OJT as scheduled?
Yes
No
Please describe what’s preventing you from staying on track.
Have you been approved in your Employment Plan to receive transportation assistance (for example, gas support)?
Yes
No
Do you still need this transportation support to continue attending training?
Yes
No
Please confirm that this assistance will be used for transportation to and from training.
I Confirm
Are you currently employed by the OJT employer?
Yes
No
Please explain the circumstances that led to your separation from employment.
Have you been approved in your Employment Plan to receive transportation assistance (for example, gas support)?
Yes
No
Do you still need this transportation support to maintain employment?
Yes
No
Please confirm that this assistance will be used for transportation to and from employment-related activities.
I Confirm
Are you currently participating in the OJT?
Yes
No
Please explain the circumstances that led to your separation from employment.
Have you been actively looking for work?
Yes
No
Please tell us what’s preventing you from job searching so we can assist.
Have you been approved in your Employment Plan to receive transportation assistance (for example, gas support)?
Yes
No
Do you still need this transportation support to continue your job search activities?
Yes
No
Please confirm that this assistance will be used for transportation to and from employment-related activities.
I Confirm
Since last month, have you experienced any new barriers that could affect your ability to attend training or stay employed?
Yes
No
Would you like your Career Specialist to contact you to discuss options?
Yes
No
Briefly describe any barriers affecting your progress:
Signature
I attest that the information stated above is true and accurate
Signature
Sign Here
Date
Submit Form
An equal opportunity/employer program. Auxiliary aids and services are available upon request to individuals with disabilities.
