Are You Eligible for WIA? Find Out!

Are You Eligible For WIA? Find Out!

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To check preliminary eligibility for WIA services please complete the following questionnaire. Please print your summary page and present it to an Intake and Eligibility Specialist at your local Workforce Center.

For expedited service please print and complete this Standard Intake Form prior to visiting your local Workforce Center.

Yes No
	1.	Does your family receive food stamps or TANF? If yes, then skip the remaining questions.
	2.	Are you a US citizen?
	3.	Are you older than 14 years of age?
	4.	Are you a dislocated worker drawing Unemployment Insurance? If yes, then skip questions 5a and 5b.
	5a.	What is the size of your family?
	5b.	What is your family income? $
	6.	Are you a female? If so, skip question 6a.
	6a.	If you are a male born after January 1st, 1960, are you registered for selective service?

Family Size	1	2	3	4	5	6	7	8	> 8
Income ($)	9,570	12,830	16,440	20,290	23,950	28,010	32,070	36,130	add 4,060 per person