Page 671

VIRGINIA DEPARTMENT OF SOCIAL SERVICES SNAPET Pre-Assessment Form

10/24 VOLUME V, PART XXV, APPENDIX II, PAGE 5

SNAP E&T PRE-ASSESSMENT FORM

FORM NUMBER - 032-02-014

PURPOSE OF FORM - This form may be used prior to conducting an initial assessment to screen participants for SNAP E&T. The form records basic information concerning the participant's education level, skills and abilities, ability to read English, recent work experience, employment goal and barriers to employment.

USE OF FORM - The information on this form is used to assess the job readiness of the participant and serves as a screening tool to help the SNAP E&T Worker decide whether participation in the program is feasible.

NUMBER OF COPIES - One

DISPOSITION OF COPIES - Original must be maintained in the participant’s case record.

INSTRUCTIONS FOR PREPARATION OF FORM: - This form may be mailed to the participant, completed by the participant, signed and returned to the agency in the envelope provided by the agency. The form may also be completed by the Eligibility Worker during the certification interview.

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Page 671

Official source

VIRGINIA DEPARTMENT OF SOCIAL SERVICES SNAPET Pre-Assessment Form

10/24 VOLUME V, PART XXV, APPENDIX II, PAGE 5

SNAP E&T PRE-ASSESSMENT FORM

FORM NUMBER - 032-02-014

PURPOSE OF FORM - This form may be used prior to conducting an initial assessment to screen participants for SNAP E&T. The form records basic information concerning the participant's education level, skills and abilities, ability to read English, recent work experience, employment goal and barriers to employment.

USE OF FORM - The information on this form is used to assess the job readiness of the participant and serves as a screening tool to help the SNAP E&T Worker decide whether participation in the program is feasible.

NUMBER OF COPIES - One

DISPOSITION OF COPIES - Original must be maintained in the participant’s case record.

INSTRUCTIONS FOR PREPARATION OF FORM: - This form may be mailed to the participant, completed by the participant, signed and returned to the agency in the envelope provided by the agency. The form may also be completed by the Eligibility Worker during the certification interview.

TRANSMITTAL #35