Screening Form for the Excluded Worker Fund | Columbia County Sanctuary Movement CRM

Screening Form for the Excluded Worker Fund

Please fill this screening tool out carefully. This is not an official determination, but is based on the guidelines set by the New York State Department of Labor (DOL). If you have any questions or concerns about your eligibility, contact CCSM at (518)303-3848. Once you fill this form out, someone will be in touch to follow up if you are eligible for the fund and within our area of support (Capital Region and Upper Hudson Valley in New York).

If you are looking for more information about the fund, visit our site by clicking here.

 
 
 
 
Were you eligible for or did you receive any of the following benefits or income relief during the pandemic?
 
Were you eligible for or did you receive any of the following benefits or income relief during the pandemic?
 
 
 
 
Be sure to scroll to view all options. Must have a total of 4 points for Proof of Identity. Any documents that are not in English must be accompanied by a certified English language translation (applicants can self-certify translations).
Be sure to scroll to view all options. See next question for additional options. Must have either one document from this section or two from the next for Proof of Residency.
Be sure to scroll to view all options.
Be sure to scroll to view all options. Must have a total of 5 points for Tier 1 or 3 points for Tier 2 for Proof of Work History.
 
 
 
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