"WIA DOCUMENTATION CHECKLIST"
Youth Opportunities Consortium YOUTH WITH SPECIAL NEEDS ELIGIBILITY DOCUMENTATION CHECKLIST If you are enrolled in a Special Education Program, the following must be submitted to determine your eligibility for program services. Please submit one document per category. Name: FOR STAFF ONLY Social Security No.: _ Documents Date Staff Received Received Initials Category A: AGE AND CITIZENSHIP Citizen Your Birth Certificate/Hospital Record NUMI Printout (obtain at Social Security Office) Baptismal (must include birth date and place) Naturalization Certificate Non-Citizen Right to Work Authorization Passport Category B: SOCIAL SECURITY NUMBER Social Security Card NUMI Printout (obtain at Social Security Office) Letter from Social Service Agency Category C: RESIDENCY “Date mailed” must be within 45 days of Program Application. If you have a P.O. Box Number, you still need to show your street address. Utility bill showing the street address School records Postmarked mail addressed to you Other: Category D: SPECIAL EDUCATION/PHYSICALLY DISABLED YOUTH Special Education letter completed by a Special Education teacher on school letterhead Doctor’s Statement Social Security Administration Disability Records Category E: INCOME If you worked in the last 6 months, submit pay stubs that reflect last 6 months of income. Category F: SELECTIVE SERVICE All male applicants who are or will become 18 years of age during the program must submit one of the following: Selective Service Card Telephone Verification Internet Registration/Verification EDA Staff Signature Date YOUTH 448-26 (Revised 09/25/01)