WIA & TANFAPPLICATION

REQUIREMENTS

Any Youth That Tests Below 8th Grade in Reading or Math, Need Verification of ScoresNeed a Letter From the School Documenting That They Dropped Out

Need a Signed Form From a Partnering AgencyVerification From Doctor or Copy of Child’s Birth Certificate or Social Security Card

Copy Of Any Court Documentation

Need Supporting Letters From Schools, Parents, or Outside Agencies Explaining why the youth needs additional assistance from the Program. Must Be Approved By The RCWE.

If youth do not have copies of these items, please contact your County Youth Coordinator.

Youth must be registered in Selective Services and show proof of either the card received in the mail or an online

printout.Copy of benefits letter

if receiving cash or food stamps, copy of

access card.

Service authorization

signed by CYS or other agency.

Self certification or a barrier verification form signed by the youth or agency.

Must be filled out if worked within the last 6 months and include pay

stubs unless receiving cash or food stamps.

Indicate if the youth has dropped out here.

Verification from court services must be attached to this

application using the barrier verification form or court

documents.Copy of school records or

medical records.

Must list everyone that is living in the household and attach copies of pay stubs for everyone that is currently

employed.

Provide supporting documentation verifying additional or supplemental

income.

If youth is under 18 years of age, the parent

MUST sign the application here.

If the youth is under 18 years of age, the

parent MUST sign application here.

Typically only need social or school records.

By signing this, the parent agrees that their child can be photographed or videoed while participating in programs. These images can be used in promotional media and websites

for the WIA Program.

If the youth is under 18 years of age, the

parent MUST sign application here.

This is where youth/parents/agency would

verify income and barrier information.

The Youth Coordinator and partnering agency sign here to verify the above information.

This form is generally used only by youth to determine their barrier

and income.

This form is used by schools and agencies to provide information used to determine barriers for

youth.

If in school youth, school representative can fill in testing information to determine grade

level.Use the checkboxes to provide any

barrier information.

Signature of an authorized person of the referring agency.

Need verification from school, parent, or assistance office.

Date of birth MUST be filled in or application will not be processed.

Social security number is not required for this application.

Case record number or copy of benefits page.

Letter from school verifying free/reduced lunch status.

Pay stubs