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A .. QC CHILDF,EN'S <br />VF *7' T H F R A P F U T I c ARTS <br />2215 North Broadway, Santa Ana, CA 92706 (714) 547 — 5468 www.occtac.org <br />Youth Employment Program Supportive service <br />GAS CARD acknowledgement & POLICY form <br />Policy for Use of GAS CARD <br />PURPOSE OF THE POLICY <br />Youth Employment Program Participants who qualify to receive a monthly Gas Cad: <br />• Participants are eligible to receive one monthly gas card in the amount of $50.00. <br />• Participants must request a gas card in a timely manner. <br />• NO replacements will be issued in the event the gas card is lost. <br />• Participant must provide itemized receipt(s) totaling the amount provided within 30 <br />days in which the gas card has been provided and/or before receiving additional gas <br />cards. <br />• The receipt(s) must be returned to a YEP Staff member in person. If the participant <br />is unable to provide the receipt(s) in person, the participant must provide a copy of <br />the receipt(s) via text message or email to a YEP staff member. <br />• Failure to provide proof of receipt(s) will result in future loss of privilege to receive a <br />gas card. <br />AGREEMENT <br />I, _ , have read the statement above and <br />fully understand and will adhere to the requirements and expectations to receive gas cards <br />from the Youth Employment Program at OCCTAC. <br />Participant's Signature: Date: <br />