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                                                          HOPWA Monthly Progress Report Worksheet

         This worksheet is intended to help you collect project information needed to complete Exhibits B & C of the HOPWA Monthly Progress Report.
         See Worksheet Instructions for directions on using this worksheet. Please keep a file of Aother information@ (item 14 below) to specify on the
         monthly report. Names and personal data on participants must be kept confidential; a unique identifying code should be used to track
         participants. For families, list the head of household first and aggregate family information following that entry. Other family members can be
         sequentially listed to provide space for demographic information. Please use the codes as described on the following Worksheet Instructions for
         items 5 to 12.

        1.            2.         3.            4.            5.       6.       7.        8.         9.         10.       11.       12.          13.               14.
Participant=s     Date       Number of     Number of     Race     Hispanic   Age/Sex   Gross     Recent      Date      Reason    Housing     Housing      Other Information
ID Code           Entering   Adults        Children      (A,B,    /non-                Monthly   Living      Leaving   for       Type/# of   Assistance
                  Program    residing w/   residing w/   etc.)    Hispanic             Income    Situation   Program   Leaving   Bedrooms    Payment/
                             Participant   Participant            (H or N)                                                                   # of

Abcd12345601      12/01/06   2                           B        N                    000

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