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WIOA Youth Prescreening Form
Please don't fill out this input box.
First Name
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Last Name
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Additional Eligibility Requirements
*
Parent or pregnant
Homeless, foster care, and/or aged out
Ex-offender
Diagnosed with a mental or physical disability
Unemployed/currently receiving unemployment for last 3 years
Low income due to wages or public assistance in the last 6 months
If 25 and older, please fill out the form and check this box. We will refer you to the WIOA adult program
In addition to being between the ages of 16-24, authorized to work in the U.S., and registered for Selective Service (if assigned male at birth), you need to meet one or more of the criteria above.
Date of Birth
*
Email
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Phone Number
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Program of Interest
Administrative Assistant
Agribusiness
Associates in Engineering Science Degree
Automotive Technology
Basic Nursing Assistant (BNA/CNA)
Computer-Aided Design
Computer Information Systems
Criminal Justice
Dental Assistant
Diesel Power Technology
Early Childhood Education
Engineering
Emergency Medical Services
Google IT Support
Greenhouse/Garden Center-Certificate
Licensed Practical Nursing
Manufacturing Technology
Marketing Management
Medical Assistant
Medical Billing and Coding
Organizational Leadership Certificate
Paramedic
Pharmacy Technician
Phlebotomy
Radiologic Technology
Registered Nursing
Therapeutic Massage
Truck Driver Training
Welding Technology (Basic and Advance)
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October 16, 2025 02:34 P.M.