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Fill out the following to see if you qualify for the WIOA Youth program.

WIOA Youth Prescreening Form

*indicates required field

First Name*

Last Name*

Please check any barriers that you can identify with:*

24 years or younger

Parent or pregnant

Homeless, foster care and/or aged out

Ex-offender

Diagnosed with a mental or physical disability

Unemployed/currently receiving unemployment or last 3 year

Lack of employment

Low income due to wages or public assistance in the last 6 months

English language learner

Basic skills deficient in reading or math (based on TABE scores, administered through WIOA staff only)

25 and older

Date of Birth*

Email*

Phone Number*

Program of Interest

Agribusiness

Automotive Technology

Basic Nursing Assistant (BNA/CNA)

Computer-Aided Design

Computer Information Systems

Criminal Justice

Diesel Power Technology

Emergency Medical Services

Google IT Support

Manufacturing Tech

Marketing Management

Medical Assistant

Office Systems

Pharmacy Technician

Radiologic Technology

Registered Nursing

Therapeutic Massage

Truck Driver Training

Welding Technology

Other

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