CBMS 1BC43L3

Phone (720) 944-3033

Case Manager Bushra Saido Denver County Department of Human Services

MY Employment PLAN | Roadmap

For Sandra L Baltazar
Appointment Date/Time: 2023-05-30 10:30 AM
Notes: Case has been transferred to Goodwill.

Employment First Original Plan Address State ID

1144 S PECOS ST APT Y074063
SINGLE PARENT 103 DENVER, CO 80223
Workforce Development ✖ Modified Plan

I am single mother with one child age 6 years old. Currently, I have section 8 and
stable housing. The highest grade I completed is some college. I last worked at
My Story Catholic Charity in April 2023. My skills are data entry, registration clerk, housing
navigator, case worker, customer service, bilingual, HIMS homeless system skills,
community outreach worker, and computer skills. My challenges are
unemployment, transportation and learning disability.
To obtain full time employment and to become self-sufficient, and to go back to
school and also to defeat my learning disability.
My Life Goals (S.M.A.R.T. Goals)

To participate in job search activity.

My Short Term Objective

Goodwill will contact me within a week to complete an individual phone

orientation. If I have questions about this appointment, I will contact Goodwill's
My Next Steps
Program Coordinator, Natasha Leyva, at 720-738-0017 or
Natasha.Leyva@denvergov.org. If I have not heard from Goodwill within one
week of this, I understand it is my responsibility to contact Natasha at Goodwill to
schedule an appointment. If my contact information changes prior to my
scheduled phone orientation, I will reach out to Natasha at G odwill to provide my
updated contact information. I will keep track of my daily routine on the provided
Activity Sheet or a calendar and have it available for all appointments.
 Goodwill is prepared to provide me with the supports I need to meet my
employment goals as well as to assist with finding childcare and transportation
County Commitments
and other case management services.

Supportive services will be issued in the amount of $114.00 for transportation for
the month of June. Ongoing Supportive Services will be issued based on their
Referrals and Resources
ongoing Eligibility for Colorado works and will be issued based on assessed need
of assistance and compliance of terms of the Individual Plan. Call DHS Customer
Service with question about benefits 720. 944. 4347 General Resources. Aunt
Bertha https.//www.auntbertha.com General Resources. Mile High United Way.
2-1-1 to assist with Childcre. https.//www.coloradoshines.com/families to assist
with Childcare.
I understand that my second appointment is to set my goals. I will start thinking
Future Action Steps about what employment goal I want to work on first and come to this meeting
prepared to discuss. I understand that if I do not attend this goal setting
appointment, I could risk losing some or all of my cash assistance.

By signing this Plan, I agree to participate in what it says. Because it is My Plan, I can change it, but I need to let my coach know ahead of
time, and will contact the county within (48) forty-eight hours of any changes, problems, or concerns. I understand that this program is time-
limited with a life time limit of (60) sixty months. I understand that if I don't hold up my end of the Plan, I may risk the consequences outlined in
the Conditions. I have had the chance to ask questions, and understand and agree with My Plan, above.

As a requirement of this Road Map, you must report all new employment. You can report this information in person, by phone, through the
mail, or in PEAK® (Colorado.gov/PEAK). Employment verification is required. This can be done by providing documents such as pay stubs, an
employer letter, etc. These documents can be uploaded through PEAK®.

By checking this box and signing below, I am stating that I do not agree with My Plan as outlined above. I am requesting a County Dispute
Resolution to resolve the disagreement.

Participant Signature

Client verbally agreed to her indivdual plan

Date

5/30/2023