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Workforce Grant Pre-Screen Form
Step
1
of
17
5%
Are you currently receiving Unemployment Benefits?
Are you currently receiving Unemployment Benefits?
(Required)
Yes
No
Are you currently receiving Supplemental Nutrition Assistance Program (SNAP)?
Are you currently receiving Supplemental Nutrition Assistance Program (SNAP)?
(Required)
Yes
No
Are you a Veteran, a Veteran’s Spouse, or a Veteran’s Dependent?
Are you a Veteran, a Veteran’s Spouse, or a Veteran’s Dependent?
(Required)
Yes
No
Do you have VA benefits?
Do you have VA benefits?
(Required)
Yes
No
Have you used VA benefits to pay for school?
Have you used VA benefits for tuition coverage?
(Required)
Yes
No
Are you currently working with or enrolled with Workforce WIOA progra?
Are you currently working with or enrolled with Workforce WIOA program
(Required)
Yes
No
Counselor's Name
(Required)
Counselor's Email
(Required)
Counselor's Phone
(Required)
Which Workforce county location are you enrolled in?
(Required)
What is your Highest level of Education?
What is your Highest level of Education?
(Required)
GED
High School Diploma
Some College
College Degree
Are you available during the hours of 8:00am - 4:00pm Monday -Thursday?
Are you available during the hours of 8:00am - 4:00pm Monday -Thursday?
(Required)
Yes
No
What county do you live/reside in?
What county do you live/reside in?
(Required)
Tarrant
Dallas
North Central Texas
Other
Are you currently employed?
Are you currently employed?
(Required)
Yes
No
Do you have a credit score higher than 670?
Do you have a credit score higher that 670?
(Required)
Yes
No
Do you want to add a strong cosigner?
Do you want to add a strong cosigner?
(Required)
Yes
No
Cosigner's Name
(Required)
First
Last
Cosigner's Date of Birth
(Required)
Month
Day
Year
Cosigner's SSN
(Required)
Cosigner's Email
(Required)
Cosigner's Phone
(Required)
Cosigner's Relationship
(Required)
Cosigner's Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Cosigner's Income
How did you hear about us?
How did you hear about us?
(Required)
Google
Newspaper
Facebook
Friends/Family Member
Mailer
School
Other
What is your Name?
First Name
(Required)
Last Name
(Required)
What is your Birthday?
Date of Birth
(Required)
What is your email address?
What is your email address?
(Required)
What is your phone number?
What is your phone number?
(Required)
