WIOA Adult/Dislocated Worker Program Application

WIOA Adult/Dislocated Worker Program Application

Scholarships are awarded based on eligibility determination, suitability criteria and the availability of training funds. Submitting an application does not mean you are funded for training by WIOA. Submitting an application is only the first step in your WIOA application process. IMPORTANT REMINDER: Please make sure to read each question carefully. Each question should be answered completely. Applications that are submitted with missing or invalid information will be considered incomplete and will not be reviewed. If you would like to check on the status of your application please contact 410-341-6010 or email training@tcclesmd.org. *PLEASE DO NOT SUBMIT ANY PERSONAL INFORMATION VIA EMAIL*
Name

First NameLast Name
Date of Birth

MonthDayYear
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number
Gender:
Level of Education:

Other
If you have a college degree, please indicate your course of study:
Please list any additional skills, degrees, licenses and/or certificates you may have. If none, please indicate N/A below:
Are you registered with Selective Service?
The Selective Service System is an independent agency of the United States government that maintains a database of registered MALE U.S. citizens and other U.S. residents potentially subject to military conscription. In order to receive WIOA scholarships, you must be registered for Selective Service as the LSWA WIOA program is federally funded. To verify your Selective Service Status, visit www.sss.gov or call 1-847-688-6888 to request a status information letter. If you are not registered for Selective Service, and there are qualifying reasons as to why you are not, please email our counselors at training@tcclesmd.org for further information.
Veteran Status:
Are you a U.S. citizen or authorized to work in the U.S.?
Are you registered on the Maryland Workforce Exchange Website?
You must be registered within the Maryland Workforce Exchange website to be eligible for this program. To register on the Maryland Workforce Exchange Website, please visit https://mwejobs.maryland.gov and register. If you have any questions, please contact training@tcclesmd.org
Employment Status:
If you are not currently employed and are not receiving unemployment insurance, how are you supporting yourself financially?:
Employment Schedule:
Current/Previous Employer:
Current/Previous job responsibilities:
Current/Previous hourly wage:
Are you receiving any of the following:
The state of Maryland recognizes family, for the purposes of income, as those living in the same household who are related by blood, marriage, or decree of court. Please indicate below the size of your family as defined:

Other
Please list the names and relationship to you of those individuals in your household:
Do you have reliable child care?
Do you have reliable transportation?
Please select what training course you are interested in:

Other
Have you previously applies to, or participated in any of our programs:
Describe your career goals and explain how this training will help you achieve them. Your response must be four sentences or more. Be specific about the job, position, or career path you plan to pursue and how this training supports your long-term employment goals. General or vague statements are not sufficient, and your application will not move forward until this requirement is met.
*Applications submitted without detailed responses are considered incomplete and will not be reviewed. Responses are utilized for IEP recording purposes, and are not used for approval/denial decision making*
Additional Information:
How did you hear about us?
*ex. Social media, Word of Mouth, Flyer*
I hereby certify that, to the best of my knowledge, the providedinformation is true and accurate.
By submitting this application, I am aware that the information I have provided will be used to run a background check required for class registration:
Please verify that you are human
Should be Empty: