Are you applying for the Ochsner LSU Health Medical Assistant "MA" Training Program? If not, please exit and select the Pre-Screening Application for WIOA. 

Please provide the following information.

* First Name
* Last Name
* Current Age
* Parish where you currently live
* Primary Phone Number
* Email address (must be checked often)
Phone number available to receive text messages
* Are you a U.S. Citizen?
If you are NOT a U.S. Citizen, are you a registered alien/refugee?
Are you registered with Selective Service (males 18 or older)?
* Are you a Veteran?
* Are you separating or retiring from the military?
If you are a recently separated veteran, please indicate your date of separation.
Are you a military spouse?
* Highest grade of education completed (check all that apply).
* List year of highest grade of education completed.
* Current school status
* The purpose of WIOA funding is to help you overcome barriers that might keep you from completing training. What type of financial assistance are you in most need of:
* What is your current employment situation?
If you are currently working, what is your hourly rate of pay?

Please complete the following for additional eligibility consideration:

* Do you or someone in your household receive food stamps (SNAP)?
* Do you or someone in your household receive welfare assistance (TNAF)?
* Are you between the ages of 17 to 24?
* Do you have a disability?
* Are you an offender?
* Are you a homeless or runaway youth?
* Are you in foster-care or have aged out of foster care?
* Are you pregnant or parenting?
* Number of family members in household (including yourself)
* Approximate household gross income for the past 12 months (includes all contributing members of the household):

Please answer the following questions to assist us in determining your eligibility as a "dislocated worker" Please answer each question carefully and accurately. 

* Are you a recently separated veteran?
* Are you the surviving spouse of a veteran who is eligible for VA benefits?
* Are you receiving or have you exhausted unemployment benefits?
* Were you laid off in the last 7 years and now making less wages than before?
* Did your previous employer close or go out of business?
* Did you work less than 20 hours a week in your last job?
* Was your last employer a temporary employment agency?
* Are you not likely to return to your previous occupation with the skills you currently have?
* Were you self-employed, but the economy or a natural disaster has put you out of business?
* Have you been dependent on the income of another family member and are no longer supported by that income; and are unemployed or underemployed and experiencing difficulty in obtaining or upgrading employment?
* Have you lost employment or your primary source of income due to COVID-19?
* I certify that the information provided is true and accurate to the best of my knowledge. Please enter today's date: