Information is Voluntary
You are a Spouse of a veteran if any of the following are true: Spouse died of a service-connected disability; Spouse is considered MIA / captured / forcibly detained; Spouse has a total disability resulting from service-connected disability as determined by the VA; Spouse died while a disability was in existence; Spouse died while serving on active duty
You are receiving eligibility-based services if any of the following are true: You submitted an application and/or provided personal information in order to qualify for workforce services you are now receiving; You are receiving support services such as transportation-related assistance in the form of bus passes or money on a reloadable debit card; You are in training for which Workforce Solutions is paying all or part of the costs; You are in a work placement / internship position that was arranged by Workforce Solutions with the employer, and Workforce Solutions is funding all or part of your wages; You are looking for a job or doing some other activity in which you meet with a Workforce Solutions staff person on a regular basis (such as weekly or monthly appointments)
Fill in all that apply.
Not rolled over within 60 days of withdrawal
Please use a separate application for additional household members.
Information is voluntary
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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