HPGT Screening

Eligibility Pre-Screening Questions

Please fill in the form below
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
What county do you live in?
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Are you currently employed either part time or full time?
If not currently employed, do you have a verifiable job start date?
Are you a member of a household with minor children?
Do you have a current valid Minnesota driver's license?
Are you currently working with an Employment Specialist at a Vocational Services Agency?
Are you currently receiving assistance such as DWP (Diversionary Work Program) or MFIP (Minnesota Family Investment Program)?
Do you currently own a vehicle?
What is your current monthly gross income?
Should be Empty:

Eligibility Pre-Screening Questions