You must have JavaScript enabled to use this form. First Name Last Name Birthdate Email ctcLinkID If you are an admitted student Sex Female Male Non-Binary No Answer/Prefer Not to Disclose Hispanic or Latino No Yes Race American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White School Level No Schooling Grades 1-5 Grades 6-8 Grades 9-12 (no diploma) High School Diploma or alternate High School Equivalent (e.g. GED®) Some college or technical College or professional degree Unknown School Country In the U.S. Not in the U.S. Employment Status Employed Not employed but looking for work Not looking for work currently Retired not working Temporarily not working but returning to same employer Received termination notice or separating from military WIOA Employment Considerations Bias Considerations - a person who perceives themself as possessing attitudes, beliefs, customs, or practices that influence a way of thinking, acting, or working that may serve as a hindrance to employment. Displaced Homemaker - a person who previously provided unpaid services to the family (for example: a stay-at-home parent), is no longer supported by the spouse, or is the dependent spouse of a member of the Armed Forces, is unemployed or underemployed, and is having trouble finding or upgrading employment. English Language Learner - a person with limited ability in speaking, reading, writing, or understanding the English language. Exhausting TANF - a person within 2 years of using up lifetime eligibility. Foster Care - a person who is currently in foster care or has aged out of the foster care system. Homeless - a person without a fixed, regular, and adequate nighttime residence or runaway youth. Disability - a person with a physical or mental impairment that substantially limits one or more of the person's major life activities. Justice Involved - a person who has been subject to any stage of the criminal justice process. Long Term Unemployed - a person who has been unemployed for 27 or more consecutive weeks. Low Income Individual - a person who within 6 months has received income-based assistance, such as housing supplement or food stamps, or whose total family income is below 70 percent of the lower living standard income level. Skills Development - a person wanting to improve their ability to compute and solve problems, or read, write, or speak English at a level necessary to function on a job, in their family, or in society. Single Parent - a person who is single, separated, divorced or a widowed and has primary responsibility for one or more dependent children under age 18 or is currently pregnant. WIOAFarmWorker Seasonal Farmworker A low-income individual who for the past 12 consecutive months has been primarily employed in agriculture or fish farming labor that is characterized by chronic or seasonal unemployment or underemployment and faces barriers to economic self-sufficiency. Migrant Farmworker A seasonal farmworker and whose agricultural labor requires travel to a job site such that the farmworker is unable to return to permanent place of residence within the same day. I certify that the information provided on this form is correct and true to the best of my knowledge.
