Interest Form for the WIOA Adult and Dislocated Worker Programs
Thank you for your interest! A 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 which programs you may be eligible for! (Income guidelines apply for some programs) Check all that apply
I receive, or am applying for, unemployment benefits
I receive public assistance (SNAP; MFIP; etc )
I lost my job and/or my hours were reduced due to no fault of my own
I want to change careers/obtain a credential/ or am interested in future schooling
I am currently enrolled in an education program (college, a training course, etc)
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?
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.