Tri-Parish Works/Nunez - Workforce Development Training Assistance Pre-screening

Eligibility Pre-screening

Current and enrolling students of Nunez Community College:

Many individuals that are seeking employment or training in a high demand occupation may qualify as eligible for assistance from Tri-Parish Works Business and Career Solutions Centers and the Workforce Development Board. Your answers to these questions will help us determine if you meet initial criteria for certain funding assistance, that may include, tuition, supplies, tools, fees, child care, or transportation. Please complete all questions with accurate information so that we may assess your situation and provide the most assistance. If you are likely to be eligible based on your answers, you will be contacted to provide additional documentation to verify your eligibility.

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* 1. Please provide the following contact information

First Name *

Last Name *

Last 4 of SSN (optional, but helps us find you in our system)

Parish you where you currently live: *

Primary Phone Number: *

Alternate Phone Number:

Email Address that is checked often: *

Phone Number that is available to receive Text Message:

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* 2. What is the name of the training, degree or certificate program.

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* 3. Please enter your enrollment dates, including day (if known), month, and year. You do not have to be a first-time student.

Start date of enrollment:

Expected completion date:

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* 4. Are you enrolled in the Adult Education Program at Nunez Community College to complete the requirements for your high school diploma?

Yes

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* 5. The purpose of the financial assistance we provide is to help remove barriers and obstacles that make it harder to complete training in a high-demand occupation. Let us know what areas you are struggling with the most:

Tuition (full or part)

Cost of Supplies, Tools or Uniforms

Cost of Transportation

Cost of Childcare

Other (please specify)

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* 6. What is your current employment situation?

I am not currently working

I am currently working full-time (more than 30 hrs a week)

I am currently working part-time

If you are currently working, what is your hourly rate of pay?

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* 7. Please answer the following questions to assist us in determining your eligibility as a "dislocated worker" Please answer each question carefully and accurately.

	Yes	No
Are you a recently separated veteran?	Are you a recently separated veteran? Yes	Are you a recently separated veteran? No
Are you the surviving spouse of a veteran who is eligible for VA benefits?	Are you the surviving spouse of a veteran who is eligible for VA benefits? Yes	Are you the surviving spouse of a veteran who is eligible for VA benefits? No
Are you receiving or have you exhausted unemployment benefits?	Are you receiving or have you exhausted unemployment benefits? Yes	Are you receiving or have you exhausted unemployment benefits? No
Was your employment impacted by COVID?	Was your employment impacted by COVID? Yes	Was your employment impacted by COVID? No
Did your previous employer close or go out of business?	Did your previous employer close or go out of business? Yes	Did your previous employer close or go out of business? No
Did you work less than 20 hours a week in your last job?	Did you work less than 20 hours a week in your last job? Yes	Did you work less than 20 hours a week in your last job? No
Was your last employer a temporary employment agency?	Was your last employer a temporary employment agency? Yes	Was your last employer a temporary employment agency? No
Are you not likely to return to your previous occupation with the skills you currently have?	Are you not likely to return to your previous occupation with the skills you currently have? Yes	Are you not likely to return to your previous occupation with the skills you currently have? No
Were you self-employed, but the economy or a natural disaster has put you out of business?	Were you self-employed, but the economy or a natural disaster has put you out of business? Yes	Were you self-employed, but the economy or a natural disaster has put you out of business? No
Have you been dependent on the income of another family member and are no longer supported by that income; and are unemployed or underemployed and experiencing difficulty in obtaining or upgrading employment?	Have you been dependent on the income of another family member and are no longer supported by that income; and are unemployed or underemployed and experiencing difficulty in obtaining or upgrading employment? Yes	Have you been dependent on the income of another family member and are no longer supported by that income; and are unemployed or underemployed and experiencing difficulty in obtaining or upgrading employment? No

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* 8. If you indicated that you are a recently separated veteran, please indicate your date of separation.

Date of separation:

Date

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* 9. Please complete the following for additional eligibility consideration:

	Yes	No
Do you or someone in your household receive Food Stamps (SNAP):	Do you or someone in your household receive Food Stamps (SNAP): Yes	Do you or someone in your household receive Food Stamps (SNAP): No
Do you or someone in your household receive Welfare Assistance (TANF):	Do you or someone in your household receive Welfare Assistance (TANF): Yes	Do you or someone in your household receive Welfare Assistance (TANF): No

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* 10. Please complete the following for additional eligibility consideration:

Number of family members in household (including yourself):

Approximate household gross income for the past 6 months (includes all contributing members of the household):

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* 11. I certify that the information provided is true and accurate to the best of my knowledge. Please enter today's date

Today's date:

Date

Thank you for completing the pre-eligibility application. If you are determined eligible you will be contacted by your local Business and Career Solutions Center to complete your application and provide the following documentation:

> Valid Driver's License or State ID
> Social Security Card and/or other identification verification
> Employment history, including dates of employment
> If a male over the age of 18, Selective Service verification
> If a veteran, DD-214

If enrolled in a "Pell" eligible training program, you will also need to complete the FAFSA.

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* 12. Please register or update your information in HiRE at www.Laworks.net. The more updated and complete this information is, the more quickly we can process your eligibility determination. Even if you are not eligible, registering in HiRE will give you a head start in finding that future career that you have always wanted.

Feel free to use this space to tell us about your career interests to help us better understand your needs. Also, feel free to let us know if you have any questions or concerns that you would like to have answered by a staff member of the Business and Career Solutions Centers.