GN 6365 for Self-Initiated Programs
1. The participants are responsible for completing the top section of the form their daily actual hours of participation each month. Actual hours of participation include a combination of classroom time and course related activities, such as lab, internship, work study hours, and supervised study time.
Note: study hours should be separated from class time.
2. Schools complete the midsection (above absence reporting) to verify enrollment status of a participant during the month report. The school is responsible for annotating the name, title, phone number and signature of the contact person, along with the school's stamp (embossment or seal.).
3. The participants are responsible for completing the "Absence Reporting" section to report any absences as instructed on the back side of the form.
Printout from a verified electronic attendance record: It must contain the participant's name, the name of the school, the number of hours, and the name and phone number of the person verifying the hours.
Current report card: If a current report card is not available, the participant can complete an affidavit or temporary self-certification until the report cars can be produced or its equivalent (i.e. transcripts).
Verbal third party verification: Requires a release of information to be on file in the participant's GAIN case. GSW must document: the date, the name, the title, and the phone number of the person verifying the hours.
Supportive Services should NOT be delayed or stopped if the GN 6365 has not been turned in.
Supervised Study Time: Schools are asked to provide participants with verification of supervised study time to attach to the GN 6365.
SIP STUDY TIME: SIP study time is counted, if the participant receives:
- Credit and/or units for the study time.
- Non-credit study time that is supervised and documented by the school.
Participants must obtain verification of supervised study time from their school to attach to the GN 6365 to submit to the Regional Office.
Unsupervised study time does NOT count as hours of participation on the GN 6365 for SIP.