Illinois workNet Center

Welcome

Services and Programs

Online Application Form

Services for the Recently Unemployed

Support Services

FAQs

Veterans' Information

Moraine Illinois workNet Center Initial Application Form

Directions: Complete the entire application form below. Please note that much of the information is required in order to conduct a review for eligibility under the WIA grant. If you cannot complete the entire form at this time, you may print the form and enter the information online at a more convenient time. After you have completed the form online, you must click “Submit” to send the form to the Illinois workNet Center at Moraine Valley Community College.

It is highly recommended that you include an email address in the form so we can respond to your application more easily. If you do not have an email address, you may set up a free email account at www.yahoo.com. Just set up your account from the link on the home page.

Other important application information: In addition to our online application below, we ask that individuals interested in WIA services through Moraine Valley also complete the following applications:

FAFSA Application www.fafsa.ed.gov
a. All applicants interested in WIA services must complete a Free Application for Federal Student Aid (FAFSA) application as soon as possible. We strongly recommend applicants complete the FAFSA at the same time they complete the WIA online application.
b. Students should receive a Student Aid Report (SAR) within 48 hours of submitting the online FAFSA. They must provide a copy of their SAR to our office upon receipt. The SAR may be submitted in person at our office (T100) or emailed to kirkseyc@morainevalley.edu.
WIA participants who are veterans (*Veterans applying for WIA must also submit the long version (version #4) of their DD214 discharge form.) must complete the following and provide a copy to our office as soon as possible:
• ISAC online application as soon as possible for one of the following, depending on the type of veteran applicant, and provide documentation to our office of the result of their application (similar to the SAR provided for FAFSA).

   a. ING (IL National Guard) Applications are available at www.collegezone.com/12523.htm
   b. IVG (IL Veterans Grant) Applications available at www.collegezone.com/media/F103_E_IVG.pdf
   c. MIA/POW (Missing in Action/Prisoner of War) http://www.morainevalley.edu/FinancialAid/veteran'.htm

• GI Bill application through the Veterans Administration as soon as possible (www.gibill.va.go) and provide documentation of the result of their application (similar to the SAR provided for FAFSA).
All WIA applicants must also complete the College Admission Form at Moraine Valley. The form is located at the following link:
http://www.morainevalley.edu/admiss/Default.htm

Application and Review Process:
As with any grant-funded program, eligibility alone does not entitle you to grant enrollment. Enrollment is also based on suitability. Suitability is an overall analysis of skills, work history, employment goals, academic history, and other factors that indicate a likelihood of successful grant outcomes.

*Required field

General Information Please provide demographic and contact information.
*Name:
*Address:
*City:		State:* Zip:*
Email:
*Home phone:	(xxx-xxx-xxxx)
*Cell phone:	(xxx-xxx-xxxx)
*U.S. Citizen:	Yes No Birth date:*
rized to work in U.S.: Yes No Disability: Yes No
*Are you a Veteran? Yes No
*If male and born after December 31,1959, registered for selective services? Yes No N/A
Employment: Employed Unemployed Retired

Employment History Must provide at least 1 year or more of your most recent work history and earnings.
*Current or last employer #1:
*Job title:
*Job duties:
Start date: End date: *Hours per week:
*Hourly wage:
*Status: Employed Laid off Terminated Closure Quit Other
*Collecting unemployment benefits? Yes No Exhausted benefits Did not apply

Previous employer #2:
Job title:
Job duties:
Start date: End date: Hours per week:
Hourly wage:
Status: Employed Laid off Terminated Closure Quit Other

Previous employer #3:
Job title:
Job duties:
Start date: End date: Hours per week:
Hourly wage:
Status: Employed Laid off Terminated Closure Quit Other

Household/Income Sources Please indicate the number of married and/or blood relatives who reside at the address listed above, and the sources of current monthly income.
*Indicate the number of people who reside in your household:
# of adults # of dependents under 18 years of age
Please list your current sources of income. Monthly Amount (check all that apply) (Must indicate "0" if not receiving any source.)*
	Salary/Wages (gross pay)
	Spouse income (gross pay)
	Pension
	Alimony
	Social Security Disability
	Fixed term, unearned income
	Other: Specify
	*TOTAL AMOUNT

*Do you currently receive any of the following benefits? (check all that apply):
Yes No	Food stamps
Yes No	TANF
Yes No	Unemployment benefits
Yes No	SSI
Yes No	Child support


Reason for applying
Reason for contacting Illinois workNet Center? Job search assistance What specific job are you seeking? Training What type of training are you seeking? Additional information: (maximum of 250 characters)

Confidential when completed.