Youth Services - Apply On-Line

lincoln.ne.gov

City of Lincoln
Urban Development Department - Workforce Investment Act Division

Youth Services: On-line Application

Youth Home	Come Thru	What is WIA?	Apply On-Line	Apply in Person	My First Appointment	Contact Us	FAQ

You must complete all fields marked with a *

Identification First Name* Middle Initial Last Name*

Date of Birth*

Contact Information Address*      Apt

City*      State*      Zip*

Email Address

Home Phone      Cell Phone

How did you hear about us?

Educational Information Select your current educational status:
Attending High School
Dropped out of High School
High School Graduate / GED
Attending Post High School

Financial Information Number of People in your Household*

Select your household income range for the previous 6 months*:

Check all that apply:*
Received Food Stamps or ADC in the last 6 months
Currently in Foster Care or a Ward of the State
Documented Disability, please explain:	Please provide more information about your disability.
I do not receive any Public Assistance

Obstacles to Success Do you need assistance to complete school, training, college or finding and keeping a job?
Yes No

Check any that describe your situation*:
Documented Disability
Dropped out of High School
Foster Child / Ward of the State
Homeless or Runaway
Pregnant
Parent and providing care for your child
Involved with the court, now or in the past
None of the above

Your Plans for the Future

Finish High School
Get my GED
Go to college, to study:
Get a job or find a better job
Other, please explain:

Urban Development bullet

Workforce Investment Program Division