Attachment E TABLE OF DOCUMENTATION TO ESTABLISH WIOA YOUTH PROGRAM ELIGIBILITY TABLE 1: GENERAL ELIGIBILITY REQUIREMENTS ELIGIBILITY CRITERIA Verify each eligibility criterion U.S. WORK AUTHORIZATION Note: For the list of acceptable verification documents included in the Form I-9, go to www.uscis.gov. (Applicant Statement cannot be used) SELECTIVE SERVICE REGISTRATION ACCEPTABLE DOCUMENTATION One document per eligibility criterion is required. Only the documentation sources listed below may be used. Verification documents as listed on the USCIS Form 1-9: Any one from List A; or One From List B and one from List C combined (Applicant Statement cannot be used) SOCIAL SECURITY NUMBER Note: (Must be 9 Digits) Many government agencies no longer provide the full Social Security number, listing only the last four. It is the responsibility of the applicant to provide a document with all nine numbers. (Applicant Statement cannot be used) BIRTH DATE/AGE (Applicant Statement cannot be used) Selective Service acknowledgement letter Form DD-214 - Certificate of Release or Discharge from Active Military Duty Screen printout of the Selective Service verification internet site: https://www.sss.gov/RegVer/wfVerification.aspx Selective Service registration card Selective Service verification form (Form 3A) Stamped post office receipt of registration Selective Service status information letter Evidence presented by an individual that his failure to register with the Selective Service was not knowing and willful (e.g., a written explanation accompanied by supporting documentation such as a third party affidavit) DD-214, Certificate of Release or Discharge from Active Military Duty Driver’s License (if applicable) Employment Records IRS Form Letter 1722 Letter from Social Services Agency Pay Stub Social Security Benefits Social Security Card W-2 Form Telephone verification from Cognizant Agency Baptismal record Birth certificate Form DD-214, Certificate of Release or Discharge from Active Military Duty Driver's license Federal, state or local government issued identification card Hospital record of birth Passport Public assistance/social service records School records or identification card Work permit Cross match with Department of Public Health vital records Tribal records 1 Revised 2/6/16 Attachment E TABLE OF DOCUMENTATION TO ESTABLISH WIOA YOUTH PROGRAM ELIGIBILITY TABLE 2: ESTABLISHING VETERANS’ PRIORITY ELIGIBILITY CRITERIA Verify each eligibility criterion A “covered person” under the Jobs for Veterans Act is one of the following: 1. VETERAN An individual who served in the active military, army, naval or air service that was released under conditions other than dishonorable. 2. THE SPOUSE OF: Any veteran who died of a serviceconnected disability; A member serving on active military duty who is listed as missing in action, captured in the line of duty by a hostile force, or forcibly detained or interned in the line of duty by a foreign government or power; Any veteran with a total service-connected disability rating or one who died while being evaluated for it. (Pub.L.107-288 Sec. 4215) ACCEPTABLE DOCUMENTATION One document per eligibility criterion is required. Only the documentation sources listed below may be used. DD-214, Certificate of Release or Discharge from Active Military Duty), Written communication with federal or Department of Veterans’ Affairs or other veterans’ service agency, or Telephone Verification with a government veterans’ service agency Proof of marriage to veteran through: Military spouses ID Card Marriage Certificate Proof that the veteran fits one of the categories listed through: o Military records o Newspaper article o Obituary Notice o DD-214 Written communication with federal or Department of Veterans’ Affairs or other veterans’ service agency, or Telephone Verification with a government veterans’ service agency Death Certificate Medical Records (Applicant Statement cannot be used) TABLE 3: LOW-INCOME ELIGIBILITY ELIGIBILITY CRITERIA Verify each eligibility criterion CASH PUBLIC ASSISTANCE An applicant who receives, or is a member of a family which receives cash public assistance under a federal, state or local income-based public assistance program. (Applicant Statement cannot be used) FOSTER CHILD (State or local payments are made for applicant.) (Applicant Statement cannot be used) ACCEPTABLE DOCUMENTATION One document per eligibility criterion is required. Only the documentation sources listed below may be used. Authorization to Receive Cash Public Assistance Public Assistance Check Medical Card showing Cash Grant Status Public Assistance Records Refugee Assistance Records Cross-match with public assistance database Written confirmation from a social services agency; or Court documents, that must be accompanied by case notes explaining the foster care situation. 2 Revised 2/6/16 Attachment E TABLE OF DOCUMENTATION TO ESTABLISH WIOA YOUTH PROGRAM ELIGIBILITY TABLE 3: LOW-INCOME ELIGIBILITY ELIGIBILITY CRITERIA Verify each eligibility criterion ACCEPTABLE DOCUMENTATION One document per eligibility criterion is required. Only the documentation sources listed below may be used. FREE OR REDUCED LUNCH Letter of Eligibility for free or reduced priced lunch School Documentation Applicant Statement LIVING IN A HIGH-POVERTY AREA (Applicant Statement cannot be used) Lives in a Census tract identified in San Diego as high-poverty by SDWP Proof of living on an Indian Reservation or tribal land SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) [Food Stamps] (Eligible to receive a free or reduced priced lunch under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.). (Applicant Statement cannot be used) Current Authorization to obtain Food Stamps Current Food Stamp Receipt Food Stamp Card with Current Date Letter from Food Stamp Disbursing Agency Postmarked Food Stamp Mailer with Applicable Name and Address Public Assistance Records/Printout Telephone Verification with County Welfare Office TABLE 4: LOW-INCOME ELIGIBILITY FAMILY SIZE/ INDIVIDUAL STATUS Birth Certificate Decree of Court Proof of disability (to prove individual status) Divorce Decree Landlord Statement/Lease Marriage Certificate Medical Card Most Recent Tax Return supported by IRS Documents Form Letter 1722 Public Assistance/Social Service Agency Records Public Housing Authority (If resident of, or on waiting list) Written Statement from a Publicly-Supported 24-Hour Care Facility or Institution (e.g. Mental, Prison) Telephone Verification Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. 3 Revised 2/6/16 Attachment E TABLE OF DOCUMENTATION TO ESTABLISH WIOA YOUTH PROGRAM ELIGIBILITY TABLE 4: LOW-INCOME ELIGIBILITY ELIGIBILITY CRITERIA Verify each eligibility criterion INDIVIDUAL/FAMILY INCOME Document each family member or “family of one” and their corresponding income determination and documentation. INDIVIDUAL(S) WITH DISABILITIES An individual who has a physical (motion, vision, hearing) or mental (learning or developmental) impairment which substantially limits one or more of such person’s major life activities and has a record of such an impairment, or is regarded as having such an impairment and the individual’s physical or mental impairment constitutes or results in a substantial impediment to employment. *Must prove his/her own low-income status. If the individual is over the income guidelines as an individual, it is allowable to compute the income as part of the family if it helps to meet low-income guidelines. ACCEPTABLE DOCUMENTATION One document per eligibility criterion is required. Only the documentation sources listed below may be used. Alimony Agreement Rental Agreement or Lease (Family Size) Award Letter from Veterans Administration Bank Statements (Direct Deposit or Regular Cash Deposits) Compensation Award Letter Court Award Letter Employer Statement Farm or Business Financial Records Housing Authority Verification (Family Size) Pay Stubs Pension Statement Public Assistance Records Quarterly Estimated tax for Self-Employed Persons (Schedule C) Social Security Benefits Records Unemployment Insurance Documents and/or Printout Telephone Verification Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. Letter from Drug or Alcohol Rehabilitation Agency Letter from Child Study Team Stating Specific Disability Medical Records/ Physician’s Statement Psychiatrist’s or Psychologist’s Diagnosis School Official Records or Statement Sheltered Workshop Certification Social Service Records/Referral Social Security Administration Disability Records Veterans Administration Letter/Records Vocational Rehabilitation Letter/Statement Workers Compensation Record Telephone Verification Observable Condition as Documented in a CalJOBS Case Note by Staff Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. 4 Revised 2/6/16 Attachment E TABLE OF DOCUMENTATION TO ESTABLISH WIOA YOUTH PROGRAM ELIGIBILITY TABLE 5: SPECIAL RULE/EXEMPTION FIVE PERCENT WINDOW (YOUTH PROGRAM) 5% Exception Request Form completed and approved by the SDWP Youth Program Specialist and the Youth Program Manager. (Applicant Statement cannot be used) TABLE 6: IN-SCHOOL YOUTH PROGRAM ELIGIBILITY IN-SCHOOL YOUTH (Definition) 1) Age 14 to 21, 2) Attending school; 3) At risk of dropping out of school (if applicable); 4) Low-income; and 5) Meet one or more of the following barriers: 1. 2. 3. 4. 5. 6. 7. Individual with a disability Basic skills deficient English language learner Offender Homeless, runaway, or foster child Pregnant or parenting Requires additional assistance to complete an educational program or to secure and hold employment. This has been defined locally as a youth: At risk of dropping out of school; Who is gang affiliated; Who is refugee/immigrant; Has a family history of chronic unemployment; Who resides in an area with high rates of poverty, crime and unemployment, Who has a substance abuse problem, or has a history of having such a problem; Who was formerly in foster care; With a parent or legal guardian that is incarcerated; Who is being raised by someone other than their biological parents, (such as kinship care); or Who is a first-generation high school graduate. ELIGIBILITY CRITERIA ACCEPTABLE DOCUMENTATION Verify each eligibility criterion One document per eligibility criterion is required. Only the documentation sources listed below may be used. ATTENDING SCHOOL School records Letters from school, counselor or probation officer to parent(s) Report Card Telephone Verification with relevant school personnel Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. 5 Revised 2/6/16 Attachment E TABLE OF DOCUMENTATION TO ESTABLISH WIOA YOUTH PROGRAM ELIGIBILITY TABLE 6: IN-SCHOOL YOUTH PROGRAM ELIGIBILITY ELIGIBILITY CRITERIA Verify each eligibility criterion ACCEPTABLE DOCUMENTATION One document per eligibility criterion is required. Only the documentation sources listed below may be used. AT RISK OF DROPPING OUT - Refer to Contract (OF HIGH SCHOOL OR EQUIVALENT) Drop out risk factors include: Two grades below his/her age group; Not able to obtain a work permit due to low grade point average (GPA); Below 2.0 GPA or is on their school’s D or F list; Has failed to pass the California High School Exit Exam (CAHSEE); Below minimum number of required credits for grade level; and/or Chronic attendance problems resulting in disciplinary issues (e.g. suspensions, expulsions or other documented behavioral issues resulting in a disciplinary action). School transcripts or other school records Has a documented referral by a school counselor, probation officer or other agent Letters from school, counselor or probation officer to parent(s) School or other cognizant agency’s determination youth is at risk of dropping out of high school Report card CAHSEE results Telephone Verification with principal, teachers or school counselor or other relevant personnel Truancy citation Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part of Youth Eligibility Manual. TABLE 7: OUT-OF-SCHOOL YOUTH PROGRAM ELIGIBILITY REQUIREMENTS OUT-OF-SCHOOL YOUTH (Definition) 1) Age 16-24 who is not attending any school; and meets one or more of the following categories: a) School dropout; b) Within the age of compulsory school attendance, but has not attended school for at least the most recent complete school year calendar quarter (as defined by the local school district); c) Recipient of a secondary school diploma or its recognized equivalent, who is low-income and basic skills deficient or an English language learner; d) Subject to the juvenile or adult justice system (offender); e) A homeless individual, runaway, an individual who is in foster care or has aged out of the foster care system, a child eligible for assistance under section 477 of the Social Security Act, or an individual who is an out-of-home placement; f) Pregnant or parenting; g) Low income individual with a disability; or h) Low-income individual who requires additional assistance to complete an educational program or to secure and hold employment. This has been defined locally as a youth: With limited English proficiency; Who is gang affiliated; Who is refugee/immigrant; Has a family history of chronic unemployment; Who resides in an area with high rates of poverty, crime and unemployment; Who has a substance abuse problem, or has a history of having such a problem; With a parent or legal guardian that is incarcerated; Who is being raised by someone other than their biological parents, (such as kinship care); or Who is a first-generation high school graduate. 6 Revised 2/6/16 Attachment E TABLE OF DOCUMENTATION TO ESTABLISH WIOA YOUTH PROGRAM ELIGIBILITY TABLE 7: OUT-OF-SCHOOL YOUTH PROGRAM ELIGIBILITY REQUIREMENTS ELIGIBILITY CRITERIA Verify each eligibility criterion NOT ATTENDING SCHOOL ACCEPTABLE DOCUMENTATION One document per eligibility criterion is required. Only the documentation sources listed below may be used. School Records Diploma/GEDor other recognized equivalent Telephone Verification with School/District officials Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. TABLE 8: IN-SCHOOL AND OUT-OF-SCHOOL YOUTH EMPLOYMENT BARRIERS AND ELIGIBILITY CATEGORIES BASIC SKILLS DEFICIENT The term basic skills deficient, means that an individual has English reading, writing, or computing skills at or below the 8th grade level (8.9) on a generally accepted standardized test or a comparable score on a criterion-reference test. The Act does not provide flexibility to local areas to further define basic skills deficient. (Applicant Statement Cannot Be Used) DISABILITIES (Individuals With Disabilities) Assessment by a Generally Accepted Standardized Test School Records showing test scores from a Generally Accepted Standardized Test within the last year See Documents in Table 4, above. FAMILY HISTORY OF CHRONIC UNEMPLOYMENT Documentation to verify poor employment history (from Chapter VII Attachment F-2) may include, but is not limited to: Pay Stubs Telephone verification with Employers UI records Public Assistance Records Rejection letters from employers, etc. Income determination showing income below 200% of the LLSIL for San Diego County Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. FIRST GENERATION HIGH SCHOOL GRADUATE School Records Telephone Verification with School/District officials Telephone Verification with other cognizant agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. 7 Revised 2/6/16 Attachment E TABLE OF DOCUMENTATION TO ESTABLISH WIOA YOUTH PROGRAM ELIGIBILITY TABLE 8: IN-SCHOOL AND OUT-OF-SCHOOL YOUTH EMPLOYMENT BARRIERS AND ELIGIBILITY CATEGORIES ELIGIBILITY CRITERIA Verify each eligibility criterion FORMER FOSTER CARE YOUTH GANG-AFFILIATED YOUTH A youth with one or more of the following characteristics: 1. Admits membership in or close affiliation with a gang 2. Desires to be initiated into a gang 3. Has tattoos and/or paraphernalia associated with a specific gang 4. Has been arrested in the company of a known gang member while committing a delinquent or criminal act 5. Has been confirmed as a gang member by police records, observances, and/or informants 6. Has family members who are gang-affiliated as outlined above. HOMELESS OR RUN-AWAY YOUTH ACCEPTABLE DOCUMENTATION One document per eligibility criterion is required. Only the documentation sources listed below may be used. Court Records/Documentation County Welfare Office Records/Statement Telephone Verification Written Statement from a Cognizant Agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. Assessment Interview Results School Records Police Records Letter from Probation Officer Professional Counseling Records Court Documents Written Statement from Social Service Agency Referrals from Official Agencies Telephone Verification with Cognizant Agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. Written Statement from an Individual Providing Temporary Residence Written Statement from Shelter or Social Service Agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. IMMIGRANT - See Permanent Resident Alien Permanent Resident Alien - an alien admitted to the United States as a lawful permanent resident. Permanent residents are also commonly referred to as immigrants; however, the Immigration and Nationality Act (INA) broadly defines an immigrant as any alien in the United States, except one legally admitted under specific nonimmigrant categories (INA section 101(a) (15). An illegal alien who entered the United States without inspection, for example, would be strictly defined as an immigrant under the INA but is not a permanent resident alien. Immigrant Visa granted by the Dept of State Proof of lawful permanent resident status Resident Alien Permit or Card Unexpired foreign passport Unexpired employment authorization document issued by the INS Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. 8 Revised 2/6/16 Attachment E TABLE OF DOCUMENTATION TO ESTABLISH WIOA YOUTH PROGRAM ELIGIBILITY TABLE 8: IN-SCHOOL AND OUT-OF-SCHOOL YOUTH EMPLOYMENT BARRIERS AND ELIGIBILITY CATEGORIES ELIGIBILITY CRITERIA Verify each eligibility criterion ENGLISH LANGUAGE LEARNER (Limited English Language Proficiency) The inability of an individual, whose native language is not English, to communicate in English, resulting in a barrier to employment. An individual who has a limited ability speaking, reading, writing, or understanding the English language, and whose native language is a language other than English; or who lives in a family or community environment where a language other than English is the dominant language. SUBJECT TO THE JUVENILE OR ADULT JUSTICE SYSTEM (OFFENDER) OUT-OF-HOME PLACEMENT PARENT OR LEGAL GUARDIAN INCARCERATED ACCEPTABLE DOCUMENTATION One document per eligibility criterion is required. Only the documentation sources listed below may be used. School Records Professional Counseling Records Assessment result through staff interviews or observation of inability to perform functions listed Assessment by a Generally Accepted Standardized Test Referrals from Official Agencies Written Statement from Social Service Agency Telephone Verification with Cognizant Agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. Court Documents Halfway House Resident Letter of Parole Letter from Probation Officer Police Records Telephone Verification from Cognizant Agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. Court Records/Documents Telephone Verification from Cognizant Agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. Court Documents Proof of being a Halfway House Resident Letter of Parole Letter from Probation Officer Police Records Records from a Cognizant Agency Telephone Verification from Cognizant Agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. 9 Revised 2/6/16 Attachment E TABLE OF DOCUMENTATION TO ESTABLISH WIOA YOUTH PROGRAM ELIGIBILITY TABLE 8: IN-SCHOOL AND OUT-OF-SCHOOL YOUTH EMPLOYMENT BARRIERS AND ELIGIBILITY CATEGORIES ELIGIBILITY CRITERIA Verify each eligibility criterion PREGNANT OR PARENTING RAISED BY SOMEONE OTHER THAN BIOLOGICAL PARENTS (NOT INCLUDING YOUTH IN FOSTER CARE PLACEMENT) (Only Applies to Minors) REFUGEE Any person who is outside his/her country of nationality who is unable or unwilling to return to that country because of persecution or a wellfounded fear of persecution based on the alien’s race, religion, nationality, membership in a particular social group, or political opinion. People with no nationality must generally be outside their country of last habitual residence to qualify as a refugee. (U.S. Citizenship & Immigration Services) RESIDE IN AREAS WITH HIGH RATES OF CRIME, POVERTY, AND UNEMPLOYMENT ACCEPTABLE DOCUMENTATION One document per eligibility criterion is required. Only the documentation sources listed below may be used. Birth Certificate Hospital Record of Birth Medical Card Physician Note Referrals from Official Agencies School Program for Pregnant Teens or School Records Statement from Social Services Agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. School Records Medical Records Statement from case worker or representative from HHSA Telephone Verification from a Cognizant Agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. Unexpired Refugee Travel Document Immigrant Visa granted by the Dept. of State Unexpired foreign passport Unexpired Employment Authorization document issued by the INS Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. Cognizant agency records (Police, schools, District Attorney) showing high rates of crime, poverty or unemployment in an area Newspaper articles identifying an area as high crime, a gang injunction safety zone, or an area of high poverty or high unemployment Internet site document indicating an area is: i. Enterprise or Empowerment Zone; ii. Gang injunction “safe zone” area] iii. High Crime area SANDAG Data showing high crime, high poverty areas: http://www.sandag.org Attachment M Local Barrier Data - Appendix 1-3 Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. 10 Revised 2/6/16 Attachment E TABLE OF DOCUMENTATION TO ESTABLISH WIOA YOUTH PROGRAM ELIGIBILITY TABLE 8: IN-SCHOOL AND OUT-OF-SCHOOL YOUTH EMPLOYMENT BARRIERS AND ELIGIBILITY CATEGORIES ELIGIBILITY CRITERIA Verify each eligibility criterion SUBSTANCE ABUSE PROBLEM OR HISTORY OF HAVING SUCH A PROBLEM SCHOOL DROPOUT WITHIN THE AGE OF COMPULSORY SCHOOL ATTENDANCE, BUT HAS NOT ATTENDED SCHOOL FOR AT LEAST THE MOST RECENT COMPLETE SCHOOL YEAR CALENDAR QUARTER (as defined by each local school system). ACCEPTABLE DOCUMENTATION One document per eligibility criterion is required. Only the documentation sources listed below may be used. Medical Records Police Records Court Documents School Records Written Statement from Cognizant Agency Documentation of 12-Step of meeting attendance or sponsorship Telephone Verification with cognizant agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. School Attendance Record(s) School Records School Letters identifying truancy status Telephone Verification with School/District officials confirming truancy or drop out status Telephone Verification with other cognizant agency Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. ID showing age is below 18 School records regarding attendance for the most recent complete school year calendar quarter or later Telephone Verification with School Personnel regarding attendance Truancy Citation(s) Applicant Statement if no other documents are available and is accompanied with a case note, as explained in Part I of Youth Eligibility Manual. 11 Revised 2/6/16