WIOA-YOUTH SCHOLARSHIP APPLICATION YOUTH INDIVIDUAL SERVICE STRATEGY PRE-ASSESSMENT NAME:

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1 GRADD-WIOA.10 WIOA-YOUTH SCHOLARSHIP APPLICATION YOUTH INDIVIDUAL SERVICE STRATEGY PRE-ASSESSMENT NAME: WORKFORCE INNOVATION AND OPPORTUNITY ACT Occupational Skills Training The Workforce Innovation and Opportunity Act (WIOA) is federal legislation established to provide services to Youth to enhance the development of their occupational skills and gain employment. It allows agencies to work together to provide the best resources available to assist Youth with job search and training services. The training must be for demand occupations which will lead to suitable employment in the local labor market. The Youth Program provides grants for training or education through the Workforce Innovation and Opportunity Act (WIOA). Training consists of the attainment of a certificate or Technical, Associate or Bachelor s degree through an approved training provider. To receive financial assistance, you must be determined eligible for the Youth program. Eligible Youth in the program must follow requirements established by federal legislation and local procedures. At the completion of the program, Youth are required to provide employment information to the Green River Area Development District (GRADD). WIOA training service is not an entitlement program. If you are eligible for services, there is no guarantee you will be referred for training. To apply for the WIOA Youth program, read the instructions on the following pages. You may also utilize the Kentucky Career Center or Affiliate Career Center for assistance with obtaining all of the required information that must be submitted. This pre-assessment is valid for one (1) year. You must complete all questions within the pre-assessment. Incomplete pre-assessments will not be reviewed for funding. The application must be submitted at least thirty (30) days before the date you wish to begin school. Please mail or drop off your completed pre-assessment to the address below. VETERAN SPOUSE OF VETERAN Contact Information GRADD Kentucky Career Center 3108 Fairview Drive Owensboro, KY Alisha R. Smith - (270) AlishaR.Smith@ky.gov TO BE COMPLETED BY GRADD STAFF Date Received: Staff Initials INSTRUCTIONS TO APPLY FOR PROGRAM APPROVED DENIED Staff Signature Date Sector: High Demand? YES NO The GRADD Workforce Development Department provides employers with qualified employees to enhance the economic progression within our district.

2 INSTRUCTIONS TO APPLY FOR THE PROGRAM Please make sure to read the entire pre-assessment carefully and provide all information requested. All steps must be completed and information attached before the pre-assessment can be reviewed. If you have any questions please contact one of our staff. Complete each question in every section. Incomplete pre-assessments will not be reviewed for funding. 1. Males born on or after January 1, 1960, please provide a print out of your Selective Service number. You can obtain this by going to and following instructions. 2. If you are a veteran, please attach a copy of your DD-214. If your spouse is a veteran, please attach a copy of their DD Register with or update your previous registration in Focus Career. This enables you to be matched to job openings based on your skills and experience. You must be entered in this system to be considered for the program. You can register online at (select create an account on the right side of the screen) or go to your local Kentucky Career Center or Affiliate Career Center to register. If you do not have a resume', the Focus Career system can be utilized in creating one. 4. Attach an up-to-date resume' indicating your current and previous employers as well as job skills. Resume' assistance is provided at your local Kentucky Career Center, or Affiliate Career Centers. 5. If applicable, please attach the college required testing assessment, (examples: ACT/COMPASS.) 6. Meet with an advisor at the school you have decided to attend. Once you have determined your academic plan, you will need to check the Eligible Training Provider List (ETPL) at to determine if your desired training is on the listing. Once on the ETPL home page, select Search Program ; utilize the Provider drop down tab to search for your school; once the Search tab is selected, a list of training programs will be shown for the chosen school. PLEASE NOTE: This website is best used with Windows Internet Explorer or Mozilla Firefox, some functions currently may not work with other web browsers. 7. Please attach a semester by semester academic plan which should consist of classes needed to obtain your degree. The school advisor will be able to provide this for you. 8. Include any college transcripts if you were previously enrolled in school. If you are a recent high school graduate (in the last year), please attach your transcript. 9. Apply for Federal Financial Aid by meeting with Financial Aid staff at the college or applying online at Attach documentation of application and any grant award notification. 10. Attach one or more employment opportunities that are possible and/or projected for your desired training. Labor Market Information (LMI) can be found online at under Career Information; Occupational Projections or Occupational Outlooks for the Green River Area. Job search websites showing employment opportunities in the local area can be used, such as newspaper classified ad clipping, etc.). 2

3 INSTRUCTIONS TO APPLY FOR THE PROGRAM (CONTINUED) 11. Attach Career Scope assessment (administered at the Kentucky Career Center or Affiliate Career Center). Please call to schedule an appointment. Daviess: Henderson OET: Henderson Voc. Rehab: Attach TABE Test assessment, which is given at the below county locations: If you have taken the TABE test within the last six months, you do not have to take it again. Please call to schedule an appointment. Daviess: Skill Train Hancock Hancock County-Adult Education Henderson Henderson Community College McLean Skill Train Ohio Skill Train Union Union County-Adult Education Webster Webster County-Adult Education If you are determined eligible, you will be required to attend school full-time (12 credit hours or more per semester, unless prior approval from your Career Counselor is given); please consider your source of income during training. 14. When the pre-assessment is complete, please submit to the contact listed on front page. Be reminded that all required documentation must be submitted. If the pre-assessment is incomplete it will not be accepted. NO FUNDING HAS BEEN APPROVED AT THIS POINT GRADD STAFF WILL NOTIFY YOU WHEN YOU HAVE BEEN OFFICIALLY APPROVED OR IF DENIED FOR SCHOLARSHIP PRIOR TO CLASSES STARTING. 3

4 GENERAL INFORMATION Name: SS#: - - Address: City/State/Zip County Birth Date: / / Age: Maiden Name: Phone: - - Alternate Phone Number: FAMILY INFORMATION Family Size: including yourself, state the number of people in your household who are related by blood, marriage, or adoption. Number of dependents who are less than 18 years of age: Are you a member of a family receiving Food Stamps or TANF? Yes No Are you pregnant or parenting? Are you a foster child? Yes No Yes No Please indicate the members of your household (Including yourself): Name Relation Birthdate OFFICE USE ONLY One-in-a-Family Justification: 4

5 PERSONAL & FINANCIAL INFORMATION Please mark all that apply, are currently receiving, or have received in the last 6 months: Unemployment Insurance TANF (in the last 6 months) Vocational Rehabilitation TRA (Trade Readjustment Assistance) Food Stamps (in the last 6 months) Adult Education Medical Card SSI-Supplemental Security Senior Employment Program Veteran s Assistance Section 8 Housing Migrant Worker Offender Foster Child Disability Felony Offense Pregnant or Parenting Youth Homeless Other Services/Programs: Please specify how you plan to support yourself and family throughout the entire training program. What is the gross income for yourself and your family from the last six months (if approved, documentation of your income is required): $ What is the source of income for yourself and your family? If you have a child, please describe your childcare arrangements during training: Do you have reliable transportation to get to work/school? License: Drivers CDL Motorcycle Yes No If no, what arrangements do you have to get to school/work? Have you ever received funding from GRADD before? Yes No If yes, when 5

6 EDUCATION Last grade completed: High School Diploma GED Date Received: Associates Bachelors Date Received: Major: Issuing Institution: Certificate/License: Issue Date: Issuing Organization: State: Vocational Training: Date Received: Currently Attending School (high school or college): Yes No Date Began: School: Projected Graduation Date: VETERAN S INFORMATION Military Service: Yes No Dates: Branch of Service: Are you a Veteran? Yes No Veteran Disability: Yes No Is your spouse a Veteran? Yes No Do you have a copy of your DD-214? Yes No Reason for Discharge: 6

7 EMPLOYMENT HISTORY This section covers your employment background. Starting with the most recent, please list the last three (3) jobs you have had. 1. Employer: Address/City/State: Job Title: Duties: Start Date: End Date (mm/dd/yy): Salary: Reason for Leaving: Was this your primary occupation? Yes No Wages: $ Per: Hour Day Week Month Year Hours per week: Employment Status: Employed Employed, Layoff Pending Fired Quit Laid Off Last day of work (include month, day, and year): 2. Employer: Address/City/State: Job Title: Duties: Start Date: End Date (mm/dd/yy): Salary: Reason for Leaving: Was this your primary occupation? Yes No Wages: $ Per: Hour Day Week Month Year Hours per week: Employment Status: Employed Employed, Layoff Pending Fired Quit Laid Off Last day of work (include month, day, and year): 7

8 3. Employer: Address/City/State: Job Title: Duties: Start Date: End Date (mm/dd/yy): Salary: Reason for Leaving: Was this your primary occupation? Yes No Wages: $ Per: Hour Day Week Month Year Hours per week: Employment Status: Employed Employed, Layoff Pending Fired Quit Laid Off Last day of work (include month, day, and year): Please explain any long periods of unemployment or lack of work history: What type of job-search have you conducted? JOB SEARCH Employment Service Internet Search Resource Room Walk-in Applications Newspaper Other: Identify employment contacts you have made in the past 6 weeks. These contacts should be using your current job skills. Date Contacted Employer Position Result 8

9 DEGREE PLAN - ACHIEVEMENT OBJECTIVE Complete the section below. List the school, your advisor, degree program, number of courses completed to this date, and how many you need to complete. If you plan to attend more than one school, please list. School: Location: Contact Person: Phone: Degree/Training Program Requested: Number of courses completed: Number of courses needed: Date training/classes will begin for the semester or training period requested: How many semesters are required to complete the Degree/Training Program requested? (This should reflect the number of semesters indicated on your academic plan as determined by the school.) Projected Graduation Date: ****************************************************************************************** School: Location: Contact Person: Phone: Degree/Training Program Requested: Number of courses completed: Number of courses needed: Date training/classes will begin for semester or training period requested: How many semesters are required to complete the Degree/Training Program requested? (This should reflect the number of semesters indicated on your academic plan as determined by the school.) Projected Graduation Date: ****************************************************************************************** School: Location: Contact Person: Phone: Degree/Training Program Requested: Number of courses completed: Number of courses needed: Date training/classes will begin for semester or training period requested: How many semesters are required to complete the Degree/Training Program requested? (This should reflect the number of semesters indicated on your academic plan as determined by the school.) Projected Graduation Date: 9

10 EMPLOYEE INTERVIEW Conduct an interview with a person who currently works in the same or similar occupation that you will be qualified for after attaining your degree and ask the questions below. Company: Contact Person: Phone: Title: 1. What kind of training, degree, and/or certification is required for someone to begin working in this occupation today? 2. What are your duties/responsibilities? 3. What do you enjoy about your work? (Try to give as many details as possible) 4. What do you dislike about your work? (Be as specific as possible) 5. What is the salary range for entry level and experienced people in this occupation? Entry Level: Experienced: 6. What do you feel is the employment potential for this kind of work? 10

11 Have you included all required attachments listed on pages 2 and 3? Selective Service for males born after January 1, 1960 DD 214 for you or your spouse (if a veteran) Up-to-date resume' COMPASS or ACT scores if attending a community and technical college or other assessment for college entrance if applicable Registered in Focus Career, Semester by Semester Academic Plan College transcripts if currently or previously enrolled in college If a recent high school graduate, provide your high school transcript Verified that your training program is listed on the Eligible Training Provider List (ETPL) Copy of FAFSA showing that you have applied for financial aid Labor Market Information (LMI), Employment Opportunities or Outlook for your training choice Career Scope TABE Test PREARRANGEMENTS: List any other state or federal agency you are currently receiving or seeking services from. Also list the type of service for each agency. This includes Vocational Rehabilitation, Pell grant, and scholarships. 11

12 Read and Sign Below By signing below I understand that the information provided will be used in assessing my eligibility. Further documentation may be required. I understand that a meeting with a GRADD Career Counselor will be required to develop my Individual Service Strategy (ISS). All Youth must demonstrate a need for training, a reasonable ability to complete training, and obtain employment at a self-sustaining wage in the career field desired. WIOA training service is not an entitlement program. If you are eligible for services, there is no guarantee you will be referred for training. This pre-assessment is valid for one (1) year. You must complete all questions within the pre-assessment. Incomplete pre-assessments will not be reviewed for funding. Please mail or drop off your completed pre-assessment to the address on the front page. NO FUNDING HAS BEEN APPROVED AT THIS POINT. GRADD STAFF WILL NOTIFY YOU WHEN YOU HAVE BEEN OFFICIALLY APPROVED PRIOR TO CLASSES STARTING Customer Signature Date 12