WABERS+ Student Intake Form 2023-2024 Academic Year Step 1 of 3 0% Program You are Completing(Required) ESL – English as a Second Language ABE – Adult Basic Education (includes HS+and GED) I-BEST – Integrated Basic Education and Skills Training Name(Required) First Last Quarter:(Required)Which quarter are you beginning classes?Summer 2023Fall 2023Winter 2024Spring 2024Bellevue College Email(Required) HiddenOrg Bellevue College ctcLink ID(Required) Highest Level of Schooling Completed:(Required) No Schooling Grades 1 – 5 Grades 6 – 8 Grades 9 – 12 (no diploma) High School Diploma or alternate High School Equivalent (e.g. GED®) Some college or technical, no degree College or professional degree Where did you complete your highest level of school?(Required) In the U.S. Not in the U.S. Current Employment Status:(Required) Employed or Temporarily Not Working (going back to the same employer) Not in the labor force(not employed and NOT actively looking for work) Employed, but received notice (termination of employment or military separation pending) Not Employed(not employed but actively looking and available for work) WIOA Employment Considerations– None of your responses or lack of responses will affect your ability to participate in our programs.Check any that apply. Skills Development – a person wanting to improve their ability to compute and solve problems, or read, write, or speak English at a level necessary to function on a job, in their family, or in society. Bias Considerations – a person who perceives themself as possessing attitudes, beliefs, customs, or practices that influence a way of thinking, acting, or working that may serve as a hindrance to employment. English Language Learner – a person with limited ability in speaking, reading, writing, or understanding the English language. – Displaced homemaker— a person who previously provided unpaid services to the family (for example: a stay-at-home parent), is no longer supported by the spouse, or is the dependent spouse of a member of the Armed Forces, is unemployed or underemployed, and is having trouble finding or upgrading employment. Individual with disability— a person with a physical or mental impairment that substantially limits one or more of the person’s major life activities. Justice Involved — a person who has been subject to any stage of the criminal justice process. Long-term unemployed — a person who has been unemployed for 27 or more consecutive weeks. Exhausting TANF— a person within 2 years of using up lifetime eligibility. Low-income individual — a person who within 6 months has received income-based assistance, such as housing supplement or food stamps, or whose total family income is below 70 percent of the lower living standard income level. Foster care youth— a person who is currently in foster care or has aged out of the foster care system. Single parent — a person who is single, separated, divorced or a widowed and has primary responsibility for one or more dependent children under age 18 or is currently pregnant. Homeless individual — a person without a fixed, regular and adequate nighttime residence or runaway youth. Migrant and Seasonal Farmworker — a person who is:(Required)Please select one. Seasonal Farmworker: A low-income individual who for the past 12 consecutive months has been primarily employed in agriculture or fish farming labor that is characterized by chronic or seasonal unemployment or underemploymentandfaces barriers to economic self-sufficiency. Migrant Farmworker: A seasonal farmworker and whose agricultural labor requires travel to a job site such that the farmworker is unable to return to a permanent place of residence within the same day. Dependent of Seasonal or Migrant Farmworker: A dependent of the individual described as a seasonal or migrant seasonal farmworker above. None of the above Certification(Required) I certify that the information provided on this form is correct and true to the best of my knowledge. Student Electronic Signature(Required)Include first name and last name upon agreement. Last Updated May 3, 2023
