DSHS Form 14-050 "Statement of Health, Education, and Employment" - Washington (Somali)

Form DSHS14-050 SM or the "Statement Of Health, Education, And Employment" is a form issued by the Washington State Department of Social and Health Services.

Download a PDF version of the Form DSHS14-050 SM down below or find it on the Washington State Department of Social and Health Services Forms website.

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Download DSHS Form 14-050 "Statement of Health, Education, and Employment" - Washington (Somali)

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Bayaanka Caafimaadka, Waxbarashada, iyo Shaqada
Statement of Health, Education, and Employment
A. Xogta Macmiilka
MAGACA MACMIILKA
TALEEFOON LAMBARKA MACMIILKA
LAMBARKA KAARKA AQOONSIGA MACMIILKA
TAARIIKHDA DHALASHADA
LAMBARKA DAMAANNADA BULSHADA
1. Ma codsatay ama ma heshay waxyaaban soo socda:
SSI ama manfacyada Damaannada Bulshada ee Naafonimada, taariikh:
Manfacyada Hawlgabnimo (VA), taariikh:
2. Ma daneynaysaa adeegyada tababar xirfadeedka baxnaanis ama dib u tababarid waqtigan ah?
Haa
Maya
3. Waa maxay luuqadaada aasaasiga ah?
Ma akhrin kartaa waxna maku qori kartaa luuqada
Ingiriisiga?
Haa
Maya
4. Qacanta midig maad isticmaashaa ama gacanta bidix?
Gacanta bidix
Gacanta midig
B. Xogta Caafimaadka
1. Ma leedahay xaalado caafimaad oo maskaxda ama jirka ah oo hadda la joogo kaa reebaya in aad shaqeysid?
Haa
Maya
Haddii ay haa tahay, qor dhammaan xaaladaha caafimaad ee kaa reebaya in aad shaqeysid:
2. Xaaladahan caafimaad ma lagaa daaweeyay?
Haa
Maya
Haddii ay haa tahay, fadlan nasii xogtan soo socota:
ISBITAALKA/BUKAAN SOCODKA
XAALADDA
TAARIIKHAHA
DAAWEYNTA / DAAWEYNTA AAD HESHAY
EEGTADA
C. Waxbarasho iyo Tababar
1. Waa maxay fasalka ugu sarreeya ee aad ku gaartay dugsiga (K – 12)?
2. Ma haysataa shahaaddo dibloomo dugsi sarre?
Haa
Maya
3. Ma dhigatay fasallo waxbarasho gaar ah ee loogu tala galay akhrinta, qoritaanka, ama xisaabta dugsi sarre?
Haa
Maya
HEERKA
SABABTA FASALADA
DEEGAANKA DUGSIGA AMA
FASAL WAXBARASHO GAAR AH
FASALKA
WAXBARASHADA GAARKA AH
DEGMADA
Ma dhigatay wax barnaamijyo tababar xirfadeed ama kulliyad ah?
Haa
Maya
Haddii ay haa tahay, fadlan nasii xogtan soo socota:
DHAMMEEYAY
TAARIIKHAHA BILOWGA /
SHAHAADDADA, SHATIGA, AMA
KULLIYAD AMA TABABAR XIRFADEED
DHAMMAADKA
HAA
MAYA
DARAJADA CILMIGA SARE
DSHS 14-050 SM (REV. 02/2018) Somali
Bogga 1
Bayaanka Caafimaadka, Waxbarashada, iyo Shaqada
Statement of Health, Education, and Employment
A. Xogta Macmiilka
MAGACA MACMIILKA
TALEEFOON LAMBARKA MACMIILKA
LAMBARKA KAARKA AQOONSIGA MACMIILKA
TAARIIKHDA DHALASHADA
LAMBARKA DAMAANNADA BULSHADA
1. Ma codsatay ama ma heshay waxyaaban soo socda:
SSI ama manfacyada Damaannada Bulshada ee Naafonimada, taariikh:
Manfacyada Hawlgabnimo (VA), taariikh:
2. Ma daneynaysaa adeegyada tababar xirfadeedka baxnaanis ama dib u tababarid waqtigan ah?
Haa
Maya
3. Waa maxay luuqadaada aasaasiga ah?
Ma akhrin kartaa waxna maku qori kartaa luuqada
Ingiriisiga?
Haa
Maya
4. Qacanta midig maad isticmaashaa ama gacanta bidix?
Gacanta bidix
Gacanta midig
B. Xogta Caafimaadka
1. Ma leedahay xaalado caafimaad oo maskaxda ama jirka ah oo hadda la joogo kaa reebaya in aad shaqeysid?
Haa
Maya
Haddii ay haa tahay, qor dhammaan xaaladaha caafimaad ee kaa reebaya in aad shaqeysid:
2. Xaaladahan caafimaad ma lagaa daaweeyay?
Haa
Maya
Haddii ay haa tahay, fadlan nasii xogtan soo socota:
ISBITAALKA/BUKAAN SOCODKA
XAALADDA
TAARIIKHAHA
DAAWEYNTA / DAAWEYNTA AAD HESHAY
EEGTADA
C. Waxbarasho iyo Tababar
1. Waa maxay fasalka ugu sarreeya ee aad ku gaartay dugsiga (K – 12)?
2. Ma haysataa shahaaddo dibloomo dugsi sarre?
Haa
Maya
3. Ma dhigatay fasallo waxbarasho gaar ah ee loogu tala galay akhrinta, qoritaanka, ama xisaabta dugsi sarre?
Haa
Maya
HEERKA
SABABTA FASALADA
DEEGAANKA DUGSIGA AMA
FASAL WAXBARASHO GAAR AH
FASALKA
WAXBARASHADA GAARKA AH
DEGMADA
Ma dhigatay wax barnaamijyo tababar xirfadeed ama kulliyad ah?
Haa
Maya
Haddii ay haa tahay, fadlan nasii xogtan soo socota:
DHAMMEEYAY
TAARIIKHAHA BILOWGA /
SHAHAADDADA, SHATIGA, AMA
KULLIYAD AMA TABABAR XIRFADEED
DHAMMAADKA
HAA
MAYA
DARAJADA CILMIGA SARE
DSHS 14-050 SM (REV. 02/2018) Somali
Bogga 1
D. Taariikhda Shaqo
1. Hadda la joogo ma shaqeysaa?
Haa
Maya Haddii ay haa tahay, meeqa ayaad kasbataa bil kasta?
2. Qor taariikhdaada shaqo ee 10 kii sanno ee ugu dambeeyay adigoo ka bilaabaya shaqadaada ugu dambeysay (ku soo
lifaaq warqad dheeri ah haddii loo baahdo):
CINWAANKA SHAQADA
CIDDA AAD U
SAACADAHA
BISHA IYO SANNADKA
MAXAAD U JOOJISAY IN AAD
SHAQEYNAYSAY
TODDOBAADKII
SHAQEYSID?
:
BILOOBIDA
JOOJINTA :
Noo sheeg waxa aad ka shaqeynaysay shaqadan:
CINWAANKA SHAQADA
CIDDA AAD U
SAACADAHA
BISHA IYO SANNADKA
MAXAAD U JOOJISAY IN AAD
SHAQEYNAYSAY
TODDOBAADKII
SHAQEYSID?
:
BILOOBIDA
JOOJINTA :
Noo sheeg waxa aad ka shaqeynaysay shaqadan:
CINWAANKA SHAQADA
CIDDA AAD U
SAACADAHA
BISHA IYO SANNADKA
MAXAAD U JOOJISAY IN AAD
SHAQEYNAYSAY
TODDOBAADKII
SHAQEYSID?
:
BILOOBIDA
JOOJINTA :
Noo sheeg waxa aad ka shaqeynaysay shaqadan:
CINWAANKA SHAQADA
CIDDA AAD U
SAACADAHA
BISHA IYO SANNADKA
MAXAAD U JOOJISAY IN AAD
SHAQEYNAYSAY
TODDOBAADKII
SHAQEYSID?
:
BILOOBIDA
JOOJINTA :
Noo sheeg waxa aad ka shaqeynaysay shaqadan:
CINWAANKA SHAQADA
CIDDA AAD U
SAACADAHA
BISHA IYO SANNADKA
MAXAAD U JOOJISAY IN AAD
SHAQEYNAYSAY
TODDOBAADKII
SHAQEYSID?
:
BILOOBIDA
JOOJINTA :
Noo sheeg waxa aad ka shaqeynaysay shaqadan:
CINWAANKA SHAQADA
CIDDA AAD U
SAACADAHA
BISHA IYO SANNADKA
MAXAAD U JOOJISAY IN AAD
SHAQEYNAYSAY
TODDOBAADKII
SHAQEYSID?
:
BILOOBIDA
JOOJINTA :
Noo sheeg waxa aad ka shaqeynaysay shaqadan:
CINWAANKA SHAQADA
CIDDA AAD U
SAACADAHA
BISHA IYO SANNADKA
MAXAAD U JOOJISAY IN AAD
SHAQEYNAYSAY
TODDOBAADKII
SHAQEYSID?
:
BILOOBIDA
JOOJINTA :
Noo sheeg waxa aad ka shaqeynaysay shaqadan:
CINWAANKA SHAQADA
CIDDA AAD U
SAACADAHA
BISHA IYO SANNADKA
MAXAAD U JOOJISAY IN AAD
SHAQEYNAYSAY
TODDOBAADKII
SHAQEYSID?
:
BILOOBIDA
JOOJINTA :
Noo sheeg waxa aad ka shaqeynaysay shaqadan:
3. Qor dhammaan hiwaayadaha iyo shaqada sida iskaaga ah ee aad soo qabatay 10 kii sanno ee u dambeeyay?
HADDII UU QOF KUU TURJUMAY AMA KUGU CAAWIYAY BUUXINTA FOOMKAN, GELI MIDKOOD MAGACOODA AMA XIRIIRKA IDIN KA DHAXEEYO
Waxaan qirayaa sada uu qabo sharciga ciqaabaha dhaarbeeneedka in xogta aan ku bixiyay bayaanka
Waxbarashada, Shaqada, iyo Caafimaadka in ay yihiin kuwo run iy sax ah oo dhammeystiran sida aqoontayda ugu
wanaagsan. Waxaan fahansanahay in Waaxda Adeegyada Bulshada iyo Caafimaadka laga yaabo in ay iga
doonayso in aan keeno caddaynta bayaanadayda.
SAXIIXA MACMIILKA
TAARIIKH
DSHS 14-050 SM (REV. 02/2018) Somali
Bogga 2
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