Promoting Tribal Economies Course (PTEC) 2026 Intake Application Worksheet

Promoting Tribal Economies Course (PTEC) 2026 Intake Application Worksheet
Name
Date
YesNo
YesNo
Phone
Format: (000) 000-0000.
Alt Phone
Format: (000) 000-0000.
Email
example@example.com
Street Address
City
State
ZIP Code
EMPLOYMENT AND EDUCATION INFORMATION
YesNo
If yes who is your employer
Position
HourlySalary
Pay rate
YesNo
If yes which school
How did you learn about the PTEC program
Why are you interested in PTEC?
YesNo
EMERGENCY CONTACT
Name
Phone
Format: (000) 000-0000.
I certify that the information provided above is complete and accurate to the best of my knowledge. | understand that I will need to complete an intake interview in order to complete my application for the Promoting Tribal Economies Course (PTEC | acknowledge that completing the screening worksheet and an intake interview is not a guarantee of program placement and that I will not receive any compensation for participating in the application process.
Signature

Clear
Date

MonthDayYear
Date
Promoting Tribal Economies Course (PTEC)

Individual Meskwaki Resiliency Plan
The Individual Meskwaki Resiliency Plan provides you the opportunity to note your education, employment, and personal history which may have an impact on current and future employment opportunities. These questions are designed to guide a conversation with the Workforce Development Coordinator in drafting your Individual Meskwaki Resiliency Plan (IMRP). This plan is designed to address barriers and provide resources and solutions to promote successful employment in the future. Your eligibility for the program is not impacted by your responses.

Confidentiality statement: The contents of this document and any attachments are strictly confidential and are intended solely for the individual PTEC participant and PTEC program administrators. Completed forms will be stored securely by the Coordinatori
HSGED/HSSome College2 yrBachelors +
YesNo
When did you last participate in an educational program either formal schooling or other
EMPLOYMENT HISTORY
Employer
Reason for leaving
Duration
Date last worked

MonthDayYear
Date
Employer
Reason for leaving
Duration
Date last worked

MonthDayYear
Date
Employer
Reason for leaving
Duration
Date last worked

MonthDayYear
Date
Employer
Reason for leaving
Duration
Date last worked

MonthDayYear
Date
Transportation IssuesCriminal HistoryLimited Work HistoryLimited EducationLack of ChildcareDomestic ViolenceMental or Emotional TraumaAlcohol UseDrug UseFamily ObligationsDisabilityOther
I certify that the information provided above is complete and accurate to the best of my knowledge. I understand that I will need to complete an intake interview in order to complete my application for the Promoting Tribal Economies Course (PTEC | acknowledge that completing the screening worksheet and an intake interview is not a guarantee of program placement.
Signature

Clear
Date

MonthDayYear
Date
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Promoting Tribal Economies Course (PTEC) 2026 Intake Application Worksheet

EMPLOYMENT AND EDUCATION INFORMATION

EMERGENCY CONTACT

Promoting Tribal Economies Course (PTEC)

EMPLOYMENT HISTORY