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Do I Qualify for PITTworks?

  1. This form will ask you up to 11 questions. If you make a mistake and need to change any of your answers, please start over by closing the form and re-opening it.

  2. Do you currently receive Food & Nutrition Services (food stamps) from Pitt County?*

  3. How old are you?*

  4. Is there anyone less than 18 years old who lives with you?*

  5. Are you in school or a training program on at least a half time basis?*

  6. Are you currently employed?*

  7. Are you currently employed?*

  8. A How many hours do you work at your job in a typical week?*

  9. How many hours to do you work at your job in a typical week?*

  10. Are you receiving Supplemental Security Income ("SSI"), or Social Security Disability benefits, or Work First Family Assistance, or Unemployment Insurance benefits?*

  11. Are you receiving Supplemental Security Income ("SSI"), or Social Security Disability benefits, or Work First Family Assistance, or Unemployment Insurance benefits?*

  12. Have you applied for Unemployment Insurance benefits, but have not yet heard whether your application will be approved?*

  13. Have you applied for Unemployment Insurance Benefits, but have not yet heard whether your application will be approved?*

  14. Are you physically and mentally able to work at least 20 hours per week?*

    Reasons that you may be unable to work may include any physical or mental disability, including dependence on alcohol or drugs. If you claim any type of disability, you may be required to provide confirmation from a professional.

  15. Are you unable to work at least 20 hours per week because you must care for a disabled adult?*

    If so, you may be required to provide confirmation from a professional.

  16. Are you living either on the streets or at the Community Crossroads homeless shelter?*

  17. Would you like to have a DSS staff member contact you to discuss your eligibility?*

    If so, please give us your name, address, and phone number below. Then prove you're not a robot, and click Submit.

  18. Leave This Blank:

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