Career Education Registration Form

Career Education Registration Form

WIOA Grant Funding
Participant Name *

First Name Last Name
Participant Email (this email will be used to access classes--must be active email that participant can access) *
example@example.com
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Course Registration

Please indicate which courses to register you for. You may select more than 1 course.
Course(s) that participant is registering for: *

Personal Career Qualities (Thursdays 2-3 pm) Job Preparation (Fridays 2-3 pm)

Required Eligibility Documentation

To attend classes under WIOA grant funding, you must upload copies of the following documents.
Upload copy of participant's Social Security Card *

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Upload copy of participant's State ID or Driver's License *

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Workforce Innovation and Opportunity Act (WIOA)

For individuals to participate in Workforce Innovation and Opportunity Act programs, they must be authorized to work in the United States. I have submitted the following documents to establish identity: 1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address. 2. Social Security Account Number card other than one that specifies on the face that the issuance of the card does not authorize employment in the United States. I certify that the information is true and accurate, and understand that the above information, if misrepresented or incomplete may be grounds for immediate termination or penalties as specified by law
Signature of participant or guardian that WIOA statement is accurate *

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Please indicate which documentation for disability status you will upload *

High school IEP Doctor's assessment with diagnosis indicated Nursing assessment (Medicaid HCBS waiver) Guardianship paperwork with diagnosis indicated
Upload documentation of participant's diagnosed disability *

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Signature of client or guardian attesting that the above information is accurate.

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Career Education Registration Form

Course Registration

Demographic Information

Required Eligibility Documentation

Workforce Innovation and Opportunity Act (WIOA)