FHEO Participant Registration

Program Registration --Please Select-- WIOA Adult WIOA Dislocated Worker WIOA Youth Non WIOA FHEO Training Track --Please Select-- Entry Level Advanced Healthcare Career Ladder Employer Sponsored Referral Current Program Status --Please Select-- Active Pending Completed Exited Date of Acceptance

Old System Record ID Financial Limit Waiver --Please Select-- Yes No Who Authorized Waiver Date Waiver Obtained

Program Year Student Number Funding Source --Please Select-- WIOA Employer Private Pay Grant Link to Intake Form

Primary Phone Number Participant Email Gender --Please Select-- Female Male Non-binary Prefer not to say Basis for WIOA Eligibility

Cohort Number Assigned Career Advisor --Please Select-- Joaquin Sharpe Shannon Coulter Randi Lawrence Kristen Meyer Huma Ahmad Maria Salinas Case Manager Email Trigger

Has Participant been entered into OSMIS? --Please Select-- Yes No Date Entered into MIS MIS Customer ID Number OSMIS Status --Please Select-- Active Inactive Pending

Applicant's Identified Healthcare Occupation Interest --Please Select-- Certified Nursing Assistant Medical Assistant Pharmacy Technician Home Health Aide Healthcare Career Score for Occupation Applicant Identified as #1 Interest --Please Select-- Yes No Date Participant Completed HCSI

Date CASAS Assessment Completed Did Participant Meet CASAS Assessment Requirements? --Please Select-- Yes No CASAS Math Score CASAS Locating Score

CASAS Reading Score Date Drug Screen Performed Results of Drug Screen --Please Select-- Pass Fail Pending Date Criminal Background Check Performed

Life Skills Provider Graduation Date Credential Training Institution Credential Pursuing

Education Level Obtained --Please Select-- HS Diploma GED Some College Associate Bachelor Was Credential Obtained? --Please Select-- Yes No Placement Date Follow-Up Date

Financial Support Status --Please Select-- Approved Pending Denied Not Requested Support Needs Program Notes Participant Status Notes