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WIA Preliminary Application

Request for Training Services

Jefferson County Community Action Council, Inc.

Mailing Address:
P.O. Box 130
Steubenville, OH 43952

WIA Office Location:
114 North Fourth Street,
Steubenville, OH 43952
740.282.0971 or Toll-Free 1.888.272.5437

Name*
Address*
City*
State*
Zip*
Phone*
e-mail*
Veteran*

Please provide the following information regarding your request for training assistance.
Training Facility you are either attending or hope to attend*
Training Program*
Start Date*
Have you lost your job due to a permanent layoff or closing of your place of employment?*

This agency DOES NOT unfairly exclude individuals from oppertunities or make decisions based upon Race, Color, Religion, National Origin, Political Affiliation, Age, or Disability.

The completion of this application DOES NOT create entitlement to services authorized under the Workforce Investment Act.

Date*