Interest Form for the Senior Community Services Employment Program (SCSEP)
Thank you for your interest! An representative for your service area will contact you with more information upon completion of this form.
First and Last Name
If you answer "YES" to any of the following items OR are interested in more information, please continue filling out this form and someone will reach out to you shortly regarding eligibility. (Income guidelines apply) Check all that apply
I am 55+
I am currently unemployed
I receive Social Security Benefits
I receive public assistance (SNAP; MFIP; etc )
I or my spouse is a veteran
Date of Birth
What is your mailing address? (Street/Po Box, City, State, Zip)
What are the best ways to reach you? (Choose all that apply)
What services are you interested in?
Employment / Job Search
What County do you live in?
Do you need an interpreter? If yes, what language
Yes- please list your preferred/needed language on the line below
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This form was created inside of Minnesota Valley Action Council.