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(530) 892-9600

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Program Forms

Applicant Statement
Adult/Dislocated Worker
(Updated 3/25/2019)

Applicant Statement
Youth
(Updated 5/28/2020)

Complaint/Grievance Summary
Click here for the Spanish Version
(Updated 9/25/2018)

Documents for Life
(Word Document)

Equal Opportunity is the Law Statement
Click here for the Spanish Version
(Updated 3/5/2019)

Eligibility Summary Checklist
Dislocated Worker
(Updated 9/23/2021)

Eligibility Summary Checklist
Youth
(Effective 1/1/2020; Last Updated 5/28/2020)

Family Income and Expense Analysis
Documentation of Financial Need for Supportive Services
(Effective 3/1/2020)

P2E Initial Interview Form
(Updated 2/23/2021)

Selective Service Affidavit
(Updated 3/25/2019)

Telephone Verification Form
(Updated 3/25/2019)

Unlikely to Return Form
Dislocated Worker
(Updated 12/6/2019)

WIOA Application
All Programs
Click here for the Spanish Version
(Updated 12/19/2022)

NORTEC IS AN EQUAL OPPORTUNITY EMPLOYER/PROGRAM. AUXILIARY AIDS AND SERVICES ARE AVAILABLE UPON REQUEST TO INDIVIDUALS WITH DISABILITIES