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Gateway Academy Screener

  1. Gateway Academy Services Request
  2. please enter the mm/dd/yyyy for your date of birth.
  3. Are you currently a Norfolk resident? *
  4. Are you currently receiving SNAP or Medicaid benefits?*
  5. Are you currently receiving TANF benefits?*
  6. Was your employment impacted by the COVID-19 pandemic?*
  7. If you answered Yes, to the above question, please check one of the below on how you were impacted by COVID-19*
    Enter N/A if you answered No to being impacted by the COVID-19 pandemic.
  8. Have you ever been convicted of a misdemeanor or felony charge*
  9. Are you between the age of 18-49 years old with no dependents on your SNAP case? Please answer N/A if you do not have SNAP benefits.
  10. Are you a youth or young adult (age 17-24) who is transitioning out of foster care?
  11. Do you have a child support case with TANF debt owed?
  12. Do you have a HS Diploma or GED?
  13. Which training program are you interested in?
  14. Leave This Blank:

  15. This field is not part of the form submission.