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Apply Now!

The following questions are designed to help us better understand the services for which you may qualify. After you complete all the questions and press the "submit information" button located at the bottom of the form, you will be presented a list of potential services. This list will be based on information you provide. Further screening by the specific service provider is required to determine final eligibility.

Employers, you need only click on the Employer Resources option to receive an accurate list of services specifically for employers.

Questions in red or marked with an asterisk are required.

1. Please identify the types of services you are seeking:
Emergency Services Employer Resources Financial Support for Getting or Keeping a Job Financial Support if Unemployed How to Find a Job How to Hire Employees Job Seeker Resources Training Services Transportation Youth Services

2. What is your race? (optional)
White (not Hispanic)
African American (not Hispanic)
Hispanic
Native American or Alaska Native
Asian or Pacific Islander
Other

3. What age group are you in?*
14-15 years of age
16-17 years of age
18-19 years of age
20-21 years of age
22-24 years of age
25-54 years of age
55-59 years of age
60 or over 60 years of age

4. What is your gender?
Male
Female

5. What is your employment status?*
Employed
Self-Employed
Unemployed
Retired

6. Sources of Income (check all that apply)*
Employment
Temporary Assistance to Needy Families (TANF), public assistance
Food Stamps
Social Security Income, Disability, or Benefits (SSI/SSD/SSB)
Gifts or Grants
School Loans
Unemployment Insurance
Veteran's Disability Benefits
Worker's Compensation
Support Service Payments
Child Care
Housing Assistance
None

7. How many people live in your home?*
1
2
3
4
5
6
7 or more

8. How many children in the household, under age 18?*
0
1
2
3
4
5
6
7 or more

9. Is anyone in the household a pregnant or parenting teen?*
Yes
No

10. Check the income range that best represents your total household income over the last 6 months.*
$0 to $3,999
$4,000 to $7,999
$8,000 to $11,999
$12,000 to $15,999
$16,000 to $19,999
$20,000 or more

11. Are you a United States Veteran?*
Yes
No

12. Do you have a disability?*
Yes, a temporary disability
Yes, a permanent disability
No, not disabled

13. If you live in Washington and you are a resident of the Benton Franklin counties, please identify which city best represents your current residence:
Benton City (includes Kiona areas)
Connell (includes Farrington, Kahlotus, McAdams, Sperry and Windust areas)
Eltopia (includes Mesa, Snake River Jct., Redd, and Ringold areas)
Kennewick (includes Hedges, Island View, and Finley areas)
Pasco (includes Glade and Burbank of Walla Walla County areas)
Paterson (includes Plymouth, Sage, and Whitcomb areas)
Prosser (includes Biggam, Chaffee, Gibbon, and Vernita areas)
Richland
West Richland

14. Are you enrolled in school?*
Yes
No

15. Highest school grade completed (General Education Development [GED] equals 12th grade)*
0 (no formal education)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

16. If you are currently receiving training or education services, please check all that apply:
General Education Development (GED)
English as a Second Language (ESL)
Adult Basic Education (ABE), reading, writing, and math
Training for a Specific Job or Career
Computer Related Training
Associate Arts (AA) Degree or Higher
None

17. During the last 12 months was over half of your earned income from:*
a.) Farm and/or nursery work
Yes
No
b.) Food canner/fresh pack processing work (not fish)
Yes
No

18. Within the past 24 months (12 months of which must have been consecutive), did you/spouse earn 50% or more of your income from agriculture?*
Yes
No

19. Are you a United States citizen?*
Yes
No

20. Can you legally work in this country?*
Yes
No

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Photo by Arlene Fowler / Select Photo Imagery

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