Revised July 1, 2017

PIRL Enrollment Form

   ver1.0.8
The Departments of Labor and Education published a notice in the Federal Register announcing the joint information collection request for performance reporting to fulfill the requirements under section 116 of the Workforce Innovation and Opportunity Act. This represents a collaborative effort among staff from the Department of Labor's Employment and Training Administration and the Department of Education's Office of Career Technical, and Adult Education and the Rehabilitation Services Administration. The information collection request included WIOA common data elements, known as the Joint Participant Individual Record Layout (PIRL), with common definitions and data elements, to be used by states for reporting purposes.

PIRL Enrollment Form

  • This enrollment form will be emailed to TVCC Adult Education at  adulted@tvcc.edu
IDENTIFYING INFORMATION
  • Submit Date
    01/21/2020
  • Application ID
      7209  
  • Language
  • Last Name
  •  *Required
  • First Name
  •  *Required
  • Middle Initial
  • Salutation
  •  *Required
  • Email Address
  •  *Required
  • Mailing Address
  • Street :   *Required
  • City :   *Required
  • State :   *Required
  • Zip Code :  (xxxxx) or (xxxxx-xxxx)   *Required
  • Primary Phone  (xxx-xxx-xxxx)
  •  *Required
  • Secondary Phone  (xxx-xxx-xxxx)
  •  *Required
  • Work Phone  (xxx-xxx-xxxx)
EQUAL OPPORTUNITY INFORMATION
  • Date of Birth
  •  *Required
  • Gender
  •  *Required
  • Individual with a Disability
    Whether the participant indicates that he/she has any 'disability', as defined in Section 3(2)(a) of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102).
    Under that definition, a 'disability' is a physical or mental impairment that substantially limits one or more of the person's major life activities.


  •  *Required
  • Category of Disability  (Select all that apply)








  •  *Required
  • Learning-Disabled Adult
    Whether the individual indicates that he/she has a learning disability, as defined as a Learner with an IQ in the low-average and above level (70+ to any level) who has deficits (related to neurological impairments) in capacity in defined limited learning areas; this can include dyslexia (reading disability), dysgraphia (writing disability), and dyscalculia (math disability). The learner also has a history of previoius educational efforts.


  •  *Required
  • Ethnicity  (Select all that apply)





  •  *Required
VETERAN CHARACTERISTICS
  • Veteran Status
    Whether the participant is a person who served on active duty in the armed forces and who was discharged or released from such service under conditions other than dishonorable.


  •  *Required
  • Eligible Veteran Status
    * Whether the participant is a person who served in the active U.S. military, naval, or air service for a period of less than or equal to 180 days, and who was discharged or released from such service under conditions other than dishonorable; (select Yes, <=180) or
    * Whether the participant served on active duty for a period of more than 180 days and was discharged or released with other than a dishonorable discharge; or was discharged or released because of a service connected disability; or as a member of a reserve component under an order to active duty pursuant to section 167(a), (d), or (g), 673 (a) of Title 10, U.S.C., served on active duty during a period of war or in a campaign or expedition for which a campaign badge is authorized and was discharged or released from such duty with other than a dishonorable discharge; (select Yes, eligible veteran) or
    * Whether the participant is:
    (a) the spouse of any person who died on active duty or of a service connected disability,
    (b) the spouse of any member of the Armed Forces serving on active duty who at the time of application for assistance under this part, is listed, pursuant to 38 U.S.C 101 and the regulations issued there under, by the Secretary concerned, in one or more of the following categories and has been so listed for more than 90 days:
       (i) missing in action;
       (ii) captured in the line of duty by a hostile force; or
       (iii) forcibly detained or interned in the line of duty by a foreign government or power; or
    (c) the spouse of any person who has a total disability permanent in nature resulting from a service connected disability or the spouse of a veteran who died while a disability so evaluated was in existence. (Select Yes, other eligible person).



  •  *Required
  • Date of Actual Military Separation
    Date on which the participant separated from the active duty with the U.S. armed forces.
  •  *Required
  • Disabled Veteran
    * Whether the participant is a veteran who served on active duty in the U.S. armed forces and who is entitled to compensation regardless of rating (including those rated at 0%); or who but for the receipt of military retirement pay would be entitled to compensation, under laws administered by the Department of Veterans Affairs (DVA); or was discharged or released from activity duty because of a service-connected disability (indicate Yes)
    * Whether the participant is a veteran who served on active duty in the U.S. armed forces and who is entitled to compensation (or who, but for the receipt of military retirement pay would be entitled to compensation) under laws administered by the DVA for a disability,
       (i) rated at 30 percent or more or,
       (ii) rated at 10 or 20 percent in the case of a veteran who has been determined by DVA to have a serious employment handicap (indicate Yes, special disabled)


  •  *Required
EMPLOYMENT and EDUCATION INFORMATION
  • Employment Status at Program Entry
    * Whether the participant
       (a) did any work at all as a paid employee,
       (b) did any work at all in his or her own business, profession, or farm,
       (c) worked as an unpaid worker in an enterprise operated by a member of the family, or
       (d) is one who was not working, but has a job or business from which he or she was temporarily absent because of illness, bad weather, vacation, labor-management dispute, or personal reasons, whether or not paid by the employer for time-off, and whether or not seeking another job (Select Employed); or
    * Whether the participant is a person who, although employed, either
       (a) has received a notice of termination of employment or the employer has issued a Worker Adjustment and Retraining Notification (WARN) or other notice that the facility or enterprise will close, or
       (b) is a transitioning service member (i.e., within 12 months of separation or 24 months of retirement (Select Employed but Received notice of Termination or Military Separation); or
    * Whether the participant is a not in the labor force (i.e., those who are not employed and are not actively looking for work, including those who are incarcerated.) (Select not in labor force); or
    * Whether the participant does not meet any one of the conditions described above (Select Not Employed)



  •  *Required
  • Long-Term Unemployed
    Whether the participant has been unemployed for 27 or more consecutive weeks at program entry.

  •  *Required
  • Type of Community
    Whether the participant resides in a location with less than 2,500 inhabitants and located outside urbanized areas (Select Rural).

  •  *Required
  • If the participant has identified that they are employed, or not unemployed, the number of hours per week that participant, on average, works.
  •  *Required
  • School Status at Program Entry



  •  *Required
  • Highest School Grade Completed












  •  *Required
  • Highest Education Level Completed at Program Entry








  •  *Required
  • Location of Highest Grade Completed
    Location where the individual completed their highest level of education

  •  *Required
PUBLIC ASSISTANCE INFORMATION
  • On Public Assistance
    Whether the participant is receiving financial assistance from Federal, State, or local government agencies, including Temporary Assistance for Needy Families (TANF) or equivalent general assistance, food stamps, refugee cash assistance, old-age assistance, and aid to the blind or totally disabled. Social Security benefits, unemployment insurance, and employment-funded disability are not included in this definition


  •  *Required
  • Expanded Eligibility for TANF
    Whether the individual is eligible for TANF services.


  •  *Required
  • Exhausting TANF within two years
    For individuals on TANF exhausting TANF in TWO years.


  •  *Required
MIGRANT SEASONAL FARMWORKER CHARACTERISTICS
  • Migrant and Seasonal Farmworker Status
    * Whether the participant is a low-income individual
       (i) who for the 12 consecutive months out of the 24 months prior to application for the program involved, has been primarily employed in agriculture or fish farming labor that is characterized by chronic unemployment or underemployment; and
       (ii) faces multiple barriers to economic self-sufficiency (Select Seasonal Farmworker); or
    * Whether the participant is a seasonal farmworker and whose agricultural labor requires travel to a job site such that the farmworker is unable to return to a permanent place of residence within the same day (Select Migrant and Seasonal Farmworker); or
    * Whether the participant is a dependent (as defined in 20 CFR 685.110) of the individual described as a seasonal or migrant seasonal farmworker above (Select A dependent of a seasonal, or migrant and seasonal farmworker).



  •  *Required
ADDITIONAL YOUTH CHARACTERISTICS
  • Foster Care Youth
    Whether the participant is a person who is currently in foster care or has aged out of the foster care system, or has been in the foster care system at any point during his/her lifetime.

  •  *Required
ADDITIONAL REPORTABLE CHARACTERISTICS
  • Homeless Individual, Homeless Children and Youths, or Runaway Youth
    Whether the participant:
    (a) Lacks a fixed, regular, and adequate nighttime residence; this includes an individual who:
       (i) is sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason;
       (ii) is living in a motel, hotel, trailer park, or campground due to a lack of alternative adequate accommodations;
       (iii) is living in an emergency or transitional shelter;
       (iv) is abandoned in a hospital; or
       (v) is awaiting foster care placement;
    (b) Has a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, such as a car, park, abandoned building, bus or train station, airport, or camping ground;
    (c) Is a migratory child who in the preceding 36 months was required to move from one school district to another due to changes in the parent’s or parent’s spouse’s seasonal employment in agriculture, dairy, or fishing work; or
    (d) Is under 18 years of age and absents himself or herself from home or place of legal residence without the permission of his or her family (i.e., runaway youth).
    This definition does not include an individual imprisoned or detained under an Act of Congress or State law. An individual who may be sleeping in a temporary accommodation while away from home should not, as a result of that alone, be recorded as homeless.

  •  *Required
  • Low Income
    Whether the participant:
    (a) Receives, or in the 6 months prior to application to the program has received, or is a member of a family that is receiving or in the past 6 months prior to application to the program has received:
       (i) Assistance through the supplemental nutrition assistance program under the Food and Nutrition Act of 2008 (7 USC 2011 et seq.);
       (ii) Assistance through the temporary assistance for needy families program under part A of Title IV of the Social Security Act (42 USC 601 et seq.);
       (iii) Assistance through the supplemental security income program under Title XVI of the Social Security Act (42 USC 1381); or
       (iv) State or local income-based public assistance.
    (b) Is in a family with total family income that does not exceed the higher of the poverty line or 70% of the lower living standard income level;
    (c) Is a youth who receives, or is eligible to receive a free or reduced price lunch under the Richard B. Russell National School Lunch Act (42 USC 1751 et seq.);
    (d) Is a foster child on behalf of whom State or local government payments are made;
    (e) Is an individual with a disability whose own income is the poverty line but who is a member of a family whose income does not meet this requirement;
    (f) Is a homeless individual or a homeless child or youth or runaway youth, or
    (g) Is a youth living in a high-poverty area.

  •  *Required
  • Immigrant
    Participant was not born in the United States, but currently resides within the country.


  •  *Required
  • English Language Learner
    Whether the participant is a person who has limited ability in speaking, reading, writing or understanding the English language and also meets at least one of the following two conditions:
    (a) his or her native language is a language other than English, or
    (b) he or she lives in a family or community environment where a language other than English is the dominant language.

  •  *Required
  • Cultural Barriers
    Whether the participant perceives him or herself as possessing attitudes, beliefs, customs or practices that influence a way of thinking, acting or working that may serve as a hindrance to employment.

  •  *Required
  • Displaced Homemaker
    Whether the participant has been providing unpaid services to family members in the home and who:
    (A)   (i) has been dependent on the income of another family member but is no longer supported by that income; or
       (ii) is the dependent spouse of a member of the Armed Forces on active duty (as defined in section 101(d)(1) of title 10, United States Code) and whose family income is significantly reduced because of a deployment (as defined in section 991(b) of title 10, United States Code, or pursuant to paragraph (4) of such section), a call or order to active duty pursuant to a provision of law referred to in section 101(a)(13)(B) of title 10, United States Code, a permanent change of station, or the service-connected (as defined in section 101(16) of title 38, United States Code) death or disability of the member; and
    (B)   is unemployed or underemployed and is experiencing difficulty in obtaining or upgrading employment.

  •  *Required
  • Dislocated Worker
    Whether the participant has received notice of pending or actual layoff from a job, or an individual who receives a publicly announced notice of pending or actual layoff.

  •  *Required
  • Ex-Offender Status at Program Entry
    An 'Offender' is a person who either:
    (A)   has been subject to any state of the criminal justice process for committing a status offense or delinquent act; or
    (B)   requires assistance in the overcoming artificial barriers to employment resulting from a record of arrest or conviction for committing delinquent acts, such as crimes against persons, crimes against property, status offenses, or other crimes.


  •  *Required
  • Single Parent
    Whether the participant is single, separated, divorced or a widowed individual who has primary responsibility for one or more dependent children under age 18 (including single pregnant women).

  •  *Required
  • Parent of ...  (Select all that apply)




  •  *Required
ONE-STOP PROGRAM PARTICIPATION
  • Participant received services under Title 1, Chapter 4, Subtitle C of WIOA (Job Corps)


  •  *Required
CORRECTIONS AND INSTITUTIONAL FUNDED PARTICIPANTS
  • In Correctional Facility
    Whether the individual is incarcerated in a state or federal penal institution for criminal offenders. This includes prisons, jails, and other correctional detention centers.

  •  *Required
  • In Community Corrections
    Whether the participant is in a community-based rehabilitation facility or halfway house.

  •  *Required
  • Other Institutionalized Setting
    Whether the participant is any other medical or special institution not included in previous categories.

  •  *Required
  • On Parole
    Whether the individual is currently on parole.

  •  *Required
  • On Probation (Community Supervision)
    Whether the individual is currently on probation.

  •  *Required
SPECIAL PROGRAM TYPE
  • Family Literacy Participant

  •  *Required
  • In Workplace Literacy Program(s)

  •  *Required
  • Participant in Job & Training Program

  •  *Required
REFERRAL TYPE
  • One-Stop Center Referral
    Whether the individual is a referral from a Workforce Solutions center.

  •  *Required
  • TANF Referral
    Whether the individual is a referral from the designated TANF agency

  •  *Required
  • Referral from College
    Whether the individual is a referral from a college or other eligible institution, placing into eligible levels based on the Texas Success Initiative (TSI) test.

  •  *Required
GOALS
  • Participant Goals  (Select all that apply)
    Goals of the participant at entry into the program.




















  • Other:  *Required
SELF-REPORTED ACHIEVEMENTS
  • Particpant Achievements  (For Office Use Only)
    Achievements reported by the program prior to the
    close of the particular program year.