WIOA Funds Available Form

Sender
WIOA May Have Funds Available
If you answer YES to one or more of the following, contact us at 919-988-6871 or 919-988-6872.
- Are you unemployed or underemployed?
- Have you been laid off from your job?
- Are you receiving public assistance?
- Do you need assistance with career development?
- Do you need assistance with job search, resume writing, interview procedures, and/or dressing for success?
Must have the following:
- US Citizen or Legal Alien
- Birth certificate or documentation
- Social Security Card
- NC Photo ID or Driver’s License
- Selective Service Registration (males only)
- Dislocated workers need:
  - Notice of layoff or no-fault termination
  - Verification of unemployment insurance status
  - Job search record
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Last 4 digits of your Social Security Number*
Program of Study (if already attending school)
What training are you interested in completing?*
Do you have a High School Diploma or High School Equivalency Diploma?*
Do you have your National Career Readiness Certificate?*
Do you live in one of the following counties?
What is your age range?*
Do you have children under the age of 18?*
Do you receive SNAP benefits?*
Do you receive Work First benefits?*
Are you employed?*
Employer Name*
Employer Address*

Employer Street Address

Employer Street Address Line 2

Employer CityEmployer State / Province

Employer Postal / Zip Code
Job Title*
Dates of Employment*
Gross Salary*
Is your Gross Salary...*
Have you completed a FAFSA?*
Have you been in WIA/WIOA before?*
If so, what program?*
Should be Empty:

WIOA May Have Funds Available