Eligibility Determination for the Adult Program

Eligibility Determination for the Adult Program

Workforce Investment Act

Eligibility Determination (Adult)

Verification Date:

  1. Individual Information:

1. Name:
2. SS#:
3. Registration Date:
  1. Eligibility Verification:

(Yes = Required documentation is in record. No = Required documentation NOT in record. N/A = Not applicable – documentation not required.)

Yes

/

No

/

N/A

/

Describe Documentation in File

1. Name
2. SS#
3. Date of Birth
4. U.S. Citizen
5. Disability
6. Pell Grant
7. Selective Service

III.Services Verification

1.Has the participant received core services? Yes No

If so what services?

outreach, intake, orientation to the system
initial assessment of skill levels, aptitudes, abilities, supportive service
determination of eligibility for services for all partner E&T programs
job search, placement assistance, career counseling
local, regional, statewide labor market information
program performance and program cost information
information on local performance
information on availability of supportive services
information on filing claims for unemployment
assistance in establishing eligibility
orientation to personal computers for access to self-directed services
follow-up activities
others (list) :
  1. Was employment attained after the receipt of core services? Yes No

Comment:

(If yes please provide employment information.)

  1. Is there documentation for the need for intensive services? Yes No

Comment:

(i.e. notes from case manager)

  1. Does the participant have a fully-developed individual employment plan (IEP)? Yes No

Comment:
5.Has the participant received intensive services? Yes No

If so what services?

customized assessment of knowledge, skills, abilities, and interests
development of an individual employment plan
group counseling
individual career planning
case management; and
short-term pre-vocational and stand-alone services
others (list)

(If yes, check to insure core services received first.)

  1. Was employment attained after the receipt of intensive services? Yes No

Comment:
  1. Is there documentation of the need for training services? Yes No

Comment:
  1. Has the participant received training services? Yes No

If so what services?

ELIGIBILITY Adult Updated February 17, 20101

occupational skills training
on-the-job training
private sector training
skill upgrading and retraining
entrepreneurial training
customized training
adult education and literacy activities provided in combination with services listed above
others (list)

(If yes, check for documentation of receipt of core and intensive services.)

  1. Was the participant made aware of the need to access alternative funding sources such as Pell Grants before WIA funds were committed and was this documented in the file?

Yes No

  1. Was a certified training provider used? Yes No

Comment:

(Are they using the state training provider list?)

  1. Was employment attained after the receipt of training services? Yes No

Comment:

(If so, where?)

  1. By Regulation, post-employment follow-up services must be provided, if appropriate, for a minimum of twelve months. Was follow up done?

Yes No

If services were needed, what was provided?

  1. Is the participant file well organized? Yes No

Comment:
  1. Is the case note method used (BROCRIP/Background, Reason, Observations, Content, Results, Impressions, Plans) or a similar method that includes the BROCRIP characteristics?

Yes No

Comment:
Yes / No /

Comments

Does the participant’s folder contain an “Equal Opportunity is the Law” Notice?
If yes, was it signed by the participant?
Does the participant’s folder contain a Complaint/Grievance Procedure Notice?
If yes, was it signed by the participant?
Additional Comments:
Local Workforce Investment Area:
Case Manager: / Date
Questionnaire Completed By: / Date:

ELIGIBILITY Adult Updated February 17, 20101

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