Free 48419.pdf - Indiana

IMPACT CLIENT AGREEMENT VOCATIONAL EDUCATION OR JOB SKILLS TRAINING
State Form 48419 (8-97) / IMP 0026

I agree to the following:
l l As outlined in my plan for employment, I will seek and accept employment while attending the Vocational Education or Job Skills Training. After researching my future occupation by interviewing at least one person who works in this occupation AND two employers who hire employees for this occupation, I agree to bring completed RESEARCHING THE OCCUPATION, INTERVIEW QUESTIONS to discuss with my IMPACT Family Case Coordinator. I will submit copies of the completed forms by this date: _________________ . After researching Vocational Education or Job Skills Training providers which offer my future course of study, I agree to bring the completed RESEARCHING VOCATIONAL EDUCATION OR JOB SKILLS TRAINING PROGRAMS questionnaires (one for each school) to discuss with my IMPACT Family Case Coordinator. I will submit copies of the forms by this date: __________________ . My course of study or training will relate directly to my employment goal as agreed upon in my plan for employment. I will only enroll in classes which relate directly to my goal or are required for the needed credential. I understand that IMPACT can only approve programs that will not exceed 12 months, or if applicable, the end of my time-limited TANF benefits, whichever is less. I understand that IMPACT will not pay for lodging, living expenses or supplies (e.g. pens, pencils, paper, briefcases). I agree to participate in job readiness activities or work related activities before enrolling in my future program if my IMPACT Family Case Coordinator believes I would benefit from these activities (such as career exploration or Work Experience). I will complete any necessary brush-up or remedial courses before enrolling in the training program to ensure my academic skills are solid enough to succeed in the program. Where possible, I will complete this work at no cost to the IMPACT Program. I will apply ONLY to public schools that are approved by the appropriate State agency. If I believe there are circumstances which should allow me to attend a private school, I agree to discuss my reasons with my Family Case Coordinator. I understand the Local Office Director must also review and approve my reasons for not using a public institution. I agree to apply for financial aid by this date: __________________ Pell Grants and scholarships will be applied toward schooling costs before IMPACT funding will be considered. If I am ineligible for financial aid, I must present proof of denial to my IMPACT Family Case Coordinator. I understand that if I am placed on academic probation or fail to meet the minimum academic or behavioral guidelines of the educational institution, IMPACT funding may be withdrawn. I agree to attend my scheduled hours of activities each week as outlined in my plan for employment. If I fail to attend without good cause my scheduled activities each week, IMPACT funding may be withdrawn. I will attend classes and notify my IMPACT Family Case Coordinator immediately if I must miss any class. I will maintain a "C" average or above or its equivalent at the education institution. I will notify my IMPACT Family Case Coordinator immediately if I begin to have difficulty understanding the course material or keeping up with my studies so that tutoring or other academic assistance can be provided (if it is available in the community). I will submit a copy of my grades to my IMPACT Family Case Coordinator at the end of each semester or quarter. I will seek and obtain written approval from my IMPACT Family Case Coordinator before I do any of the following: drop a class, discontinue attending classes, change academic programs or change schools. I will locate an instructor or other authorized school representative who will verify my monthly attendance. I will submit this information to my IMPACT Family Case Coordinator by the 5th of the following month. I will attend classes year round (12 months a year) if necessary courses are available. I will seek, accept, and retain full-time employment related to my training. If employment is not available in the field, then I will seek, accept, and retain full-time employment in another field. I understand that if I become ineligible for TANF (if I am a TANF client) or Food Stamps (if I only receive Food Stamps), IMPACT support may cease. I will contact my IMPACT Family Case Coordinator for detailed information.
Date (month, day, year)

l

l l l l l l

l

l l l l l l l l l l l

Signature of client

Signature of IMPACT Family Case Coordinator

Date (month, day, year)

DISTRIBUTION: White - Casefile; Canary - Client