WIOA Qualification Questionnaire

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

How much school have you completed? *

Which of the following best describes your current employment situation? *

Have you served in the military? *

Not a Veteran
Veteran/Served in the military
Transitioning Service Member
Spouse of a Veteran

What is your monthly income? *

How many people do you support (including yourself)? *

What kind of support do you need the most? *

I want to grow my income.
I want more education.
I want to build my skills.
I want to change my career.

I served any

Under The Applicable Provisions Of The Privacy Act Of 1974, I hereby certify, that I have not withheld any information that could affect the services that I may qualify for through West Central Arkansas Workforce Development Area (WCAWDA) and that, to the best of my knowledge, all the above information is true and correct. I understand any willful misstatement of facts may cause forfeiture of program eligibility. I understand that the above information is subject to verification, and will be handled by WCAWDA staff as "Confidential", and may be shared with other partners and/or federal, state, and/or local government/non-government agencies/organizations on a strict "need to know" basis. I agree to provide additional documentation that may be required to assess my needs relevant to WCAWDA/partner program services. By clicking the submit button, you agree to receive communications from the West Central Arkansas Workforce Development Area, including partners, via phone, mail, and email.

The Workforce Development Board of West Central Arkansas invites public comment regarding the Local Plan for PY24 – PY27. Comments will be accepted through September 19, 2024, and should be emailed to mdearmon@wcapdd.org.

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