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This monthly report is a mandatory part of your sponsorship. This report allows SNYA to keep track of your academic week. If there are questions that do not pertain to you, please put N/A in the comment section.

All questions and concerns regarding this survey and your sponsorship should go to hwri@snya.org. Failure to complete and submit the form on time may result in sponsorship jeopardy or termination. THIS FORM IS DUE THE FIRST OF EVERY MONTH, NO LATER THAN 9:00 AM, INCLUDING ALL HOLIDAYS, VACATION, SICK/PERSONAL LEAVE AND SCHOOL CLOSINGS, THROUGH COMPLETION OF YOUR EDUCATIONAL PROGRAM AND PROFESSIONAL LICENSURE AND CERTIFICATION.

If you have passed your licensing or certification exam, and have already submitted a copy of your license or certificate to SNYA, you no longer are required to submit this report weekly.

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* Indicate the following:

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* Program:

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* For students who have graduated only. Indicate the following:

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* How many absences have you had from school this month? (If any, specify the reason in the comment box below.)

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* How many days have you been late to school this month? (If any, specify the reason in the comment box below.)

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* Do you have any school closings, holidays or personal vacations coming up or scheduled? (If you have already graduated, you are still required to notify SNYA if you are leaving the city or state until completion of licensure/certification. If no, input N/A. If yes, please input your departure and return date. Location is optional)

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* Which days do you typically study in a month? (Check all that apply).

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* How many hours do you study a week?

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* What study methods do you use each week? (Check all that apply).

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* How many tests did you have this month?

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* Did you have any test scores below passing in any class this month? (Specify details below).

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* How many hours do you work as a paid employee per week?

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* What challenges did you face this month? (Check all that apply).

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* If you have faced any challenges to achieving your goal of becoming an LPN/COTA/PTA this month, what step have you taken to overcome them?

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* If you faced and selected any of the challenges above, please indicate if you would like possible assistance from the SNYA/HWRI staff, in addition to the assistance you may already be receiving.

As stated in all information sessions, all sponsored students can request an appointment with the HWRI staff for possible assistance with all issues that can possibly affect the completion of your program and licensure.

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* If there are any other questions or concerns that were not addressed on this survey, please submit them below or email hwri@snya.org so that we may better serve you.

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