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Workforce Innovation and Opportunity Act (WIOA) Intake Form

Workforce Innovation & Opportunity Act Programs

Your Success is Our Priority!

Please complete this intake form to be screened for possible grant tuition assistance:

If eligible, you may be enrolled in one or more of these services based on need and funding availability:


• Adult Education and Literacy to complete high school equivalency diploma
• Work Experience (pays at least the most current minimum wage rate)
• Career Assessment and Career Development assistance
• Financial Literacy workshops
• Assistance with college tuition and fees
• On-the-job training opportunities

Applicant Information

Address

Please answer the following questions for eligibility purposes:

Are you apart of household receiving SNAP or TANF?
Are you 24 years of age or younger, and pregnant/parenting?
Do you have any learning, mental, or physical disabilities?
Have you received unemployment insurance benefits within the past 5 years?
Are you a foster child or aged out of foster system?
Are you a veteran of the US Military?
If yes, was your discharge date within the past 5 years?
Are you the Spouse of an Armed Service Member?
Are you involved in the juvenile/adult justice system?
Are you homeless?
Do you need to obtain your high school equivalency-HiSET?

I am interested in more information about:

Signature:

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Form Successfully submitted

You'll receive a PDF copy by email and our staff will contact you shortly.

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