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 Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social Security Number
*
Gender:
*
Female
Male
Prefer not to answer
Level of Education:
*
No High School Diploma or Equivalent
High School Diploma or Equivalent
Associates Degree
Bachelors Degree
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?
*
Please Select
Yes, I am registered.
No, I need further assistance.
N/A (Female)
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:
*
Veteran
Veterans Spouse
No Status
Are you a U.S. citizen or authorized to work in the U.S.?
*
Yes
No
Are you registered on the Maryland Workforce Exchange Website?
*
Please Select
Yes, I am registered.
No, I am not registered.
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:
*
Employed
Unemployed
If you are not currently employed and are not receiving unemployment insurance, how are you supporting yourself financially?:
*
Employment Schedule:
*
Full Time
Part Time
Unemployed
Current/Previous Employer:
*
Current/Previous job responsibilities:
*
Current/Previous hourly wage:
*
Are you receiving any of the following:
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SNAP
Temporary Cash Assistance
Child Support
SSDI
SSI
None
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:
*
Yourself
Yourself and Spouse
Yourself and dependent children
Yourself, your spouse and dependent children
Other
Please list the names and relationship to you of those individuals in your household:
*
Do you have reliable child care?
*
Yes
No
Not Applicable
Do you have reliable transportation?
*
Yes
No
Please select what training course you are interested in:
*
A/C Refrigeration Intro: Refrigerant Tech (Enrollment is only in September)
Business Management (2 year programs)
Certified Nursing Assistant
Chemical Dependency Counseling (2 year)
Child Care Training
Clinical Medical Assistant
Commercial Truck Driver Refresher Training
Commercial Truck or Bus Driver: Class A
Commercial Truck or Bus Driver: Class B
Criminal Justice
Early Childhood Education
Hospitality Management
Licensed Practical Nurse
Nursing
Physical Therapist Assistant- AAS (Must be selected for this program)
Radiologic Tech (Must be selected for this program)
Other
Have you previously applies to, or participated in any of our programs:
*
Yes
No
Please describe your career goals in DETAIL and explain how participating in this training program will help you achieve them:
*
*Applications submitted without detailed responses are considered incomplete and will not be reviewed.*
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.
Please verify that you are human
*
Submit
Should be Empty: