CLC 10050E JFS03002 WIOA APPLICATION AND ELIGIBILITY DETERMINATION

WIOA YOUTH PROGRAM ELIGIBILITY APPLICATION

Thank you for your interest in A.M.P. Please complete this application to determine your eligibility for A.M.P. services. The A.M.P. Program is funded by Franklin County Commissioners, the Workforce Development Board of Central Ohio and administered by FCDJFS.
As you complete this application, you will need to reference these document types.

Photo ID (State ID, Passport, Driver's License, Current School ID)
Proof of Age (Birth Certificate, Driver's License, Passport, CRIS-E Printout)
Proof of Social Security Number (Social Security Card, W-2, FCDJFS Award with Case Number, Filed Tax Returns, CRIS-E Printout)
Proof of Household Income for the last 30 days (Pay Stubs, Employer Statement of Earnings, Social Security Retirement Benefits Letter, Child Support Payment Documentation, SSI award letter)
CONTACT INFORMATION
Applicant Name*

First NameMiddle NameLast Name
Applicant Social Security Number*
Applicant E-mail Address*
Applicant Phone Number*
Alternate Applicant Phone Number
Applicant Address*

Street Address

Apartment

CityState / Province

Postal / Zip Code
Parent Name*
Full Name
Parent Phone Number*
Parent Email*
example@example.com
YesNo

Rows	First name	Last Name	Relationship to You	Monthly Income (ONLY NUMBERS. Enter 0 if none)
Yourself
Other Family 1
Other Family 2
Other Family 3
Other Family 4
Other Family 5
Other Family 6
Other Family 7
Other Family 8
Other Family 9

WIOA YOUTH PROGRAM ELIGIBILITY APPLICATION