Pre-application for CPLC's WIOA Youth Program  for Phoenix and Metro Areas (*Maximum age: In-school 21 years, Out-of-school 24 years)  
This is an ARIZONA@WORK City of Phoenix WIOA Title 1-B Program federally funded through the Department of Labor with $1,036,078.00 (100 percent).
Each part of the pre-application must be filled accurately. Incomplete applications will not be processed.
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Today's Date *
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How did you hear about Chicanos Por La Causa's WIOA youth program? If you heard from a friend or organization, please provide the full name. *
What is your first and last name? *
Date of Birth MM/DD/YYYY *
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Age *
Street Address *
Apartment Number
City *
State *
Zip Code *
Phone Number *
Email Address *
Gender *
I am a *
What is your native language? *
Are you an English Language Learner? *
What other languages do you speak? *
Where do you currently live? *
Number of people in your household? Include yourself. *
Total "monthly income" of all working individuals in your household including yourself: *
Are you pregnant or parenting? *
Do you receive Food Stamps or Cash Assistance or Reduced Lunch at school? *
Have you ever been involved with the justice system? *
Have you ever been diagnosed with a disability? *
Are you a High School or GED graduate? *
If you are not a high school or GED graduate, what was the highest grade you completed? *
What was the name of the last school you attended? Provide the full name. *
If you dropped out of school, how many months have you been out of school? *
Are you currently enrolled or attending any school or college? *
If yes, what is the name of the school or college and what are you studying? Provide details.
What are your educational and career goals? CPLC can assist you with a short-term training program. What is the one training program that CPLC's Youth Program can help you with? *
Are you currently working? *
If yes, Part Time or Full Time?
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If unemployed, for how many weeks have you been unemployed?
Do you have reliable transportation? *
Do you have internet service at home? *
Do you have access to a computer at home? *
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