Student Update

Your answers to this questionnaire will help us determine if you are eligible for any programs that could help you pay for the K-CET term fee, GED testing, textbooks, or other supplies.

First Name:

Middle Name:

Last Name:

1. Are you currently receiving benefits from any of these programs? 

2. Employment Information 

2a. Are you employed: 

2a. Are you currently receiving weekly unemployment benefits?

3. If you don’t have a job, are you currently working with any of these programs? 

WIOA, Title I (Adult, Dislocated Worker, and Youth): A program that helps adults (18+) or youth (16-24) that are looking for a job (part or Student Update 2 full-time), to get a better job, on-the-job training, work-experience, and GED. This program supports adults who meet 1 or more of the following categories: 

• Have been laid-off from a job (dislocated workers) 
• Are currently unemployed 
• Take care of children or elderly adults at home and need to go back to work 
• Want a better job, or who are interested in short-term training to enter a different job or career (i.e. become a trucker, or medical assistant). 

Employment Services (WIOA, Title III): Oregon Employment Dept. or  “WorkSource” helps those without a job to find work.

Long-Term Unemployed: Been unemployed for 6 months or more?

Lay-Off/Business Closure: Have you received a notice that you will be laid off from your current job sometime soon? (i.e. Dislocated Worker) 

Veteran: Served in the active military & discharged or released from service. Dishonorable discharge is not eligible. 

Other: Any other type of benefits or support programs not listed above

4. Do you have any challenges that may make employment difficult? 

4a. English Language Learner: Is your native language something other than  English, and do you have limited ability to speak, read, write or understand English? or Do you live in a family or community environment where a language other than English is the dominant language?

4b. Cultural: Do you find it challenging to find a job due to being new to the U.S., or having beliefs, customs, or practices that may be different than those around you? 

4c. Migrant or Seasonal Farmworker: Applies to those who work farming jobs

Review this list of examples that might apply to you or a family member:

•  Do you have to move often due to your job in farming labor?
• Have you worked in farming for 12 months in a row out of the last 24 months?
• Are you or your spouse currently working in a farm-related job?
• Or are you the child of a farmworker? 

4d. Single Parent: Caring for 1 or more children (17 years or younger). This includes single women who are currently pregnant.

4e. Foster Care Youth: Are you currently in foster care, or were you in the foster care system when you were younger? 

4f. Enrolled in high school right now?

School Name: 

5. Do you have any additional challenges that may make employment difficult? 

5a. Individual with a Disability: Do you have a physical or mental condition, an injury or a chronic issue that limits one or more of your major life activities? This might include walking, seeing, hearing, working, learning, or other situations 

5b. Low Income: During the last 6 months have you or a family member received one of the following types of assistance?

• SNAP
• TANF
• Homeless / Housing Assistance
• Supplemental social security
• Free or reduced-price lunch
• Other public assistance 

5c. Been on TANF for 3 years? Please note that you might be within 2 years of using up or Exhausting TANF benefits (TANF has a lifetime limit of 5 years).

5d. Displaced Homemaker: Are you a stay-at-home caregiver who was (or are) caring for children or elderly relatives that are sick, injured, or disabled?

• Were you dependent on the income of a spouse or family member, but now need to return to work after several years of being at home? 
• Are you unemployed or working part-time in a low-wage job, and experiencing difficulty in getting a better job due to the time you spent caregiving?
• Or, are you the spouse of someone who is an active member of the Armed Forces, or National Guard – and was deployed? 

5. Do you have any additional challenges that may make employment difficult? (contd.)

5e. Ex-Offender: Were you involved with the criminal justice system in the past? 

 a) Were you monitored by the juvenile justice system as a youth for an act that was considered a crime due to your age? (status offense) This would include actions, such as:

• Underage drinking 
• Violating curfew 
• Truancy
• Running away from home 

 b) Are you having a hard time finding a job because of a record of arrest or conviction for an offense as a youth or an adult?

5f. Low Levels of Literacy

5g. Homeless: Do you live with friends/family, or do any of these examples apply to you?

a) Do you lack a fixed, regular, and adequate nighttime residence? This includes:

• Living with family / friends (or someone else) because you lost your housing or are having difficulty with your finances right now
• Living in a motel, hotel, trailer park, or campground because you can’t find another place to live 
• Living in a shelter or transitional housing program
• Awaiting foster care placement 

b) Do you have a primary nighttime residence that is in a public or private place not designed for regular sleeping accommodations? 

• Could include “couch-surfing” at friend’s house, sleeping in a car, park, bus/train station, airport, abandoned building, or campground 

c) Did you move in the past 36 months due to your parent(s) or stepparent(s) seasonal job in farming, dairy, or fishing work?

d) Are you under 18 years of age and not living at home for any reason?