Intake Application

About the Self-Sufficiency Fund (SSF)

The Self-Sufficiency Fund is a training program that helps individuals obtain industry-recognized credentials and move into careers that support long-term stability and independence. Please complete this application to the best of your ability and provide honest and accurate information. After your application is submitted, it will be reviewed, and eligible applicants will be contacted with next steps for approval and enrollment

Eligible individuals must meet at least one of the four criteria below. Funding may cover tuition, training materials, books, and supplies.

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Government Assistance Recipients

Adults currently receiving SNAP (food stamps), TANF (cash assistance), WIC, CHIP, or other public assistance benefits.

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At Risk of Public Assistance

Individuals who are unemployed, underemployed, or at risk of becoming dependent on public assistance benefits.

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Low Income with Dependent Child

Individuals earning less than $37,000 annually with a dependent child — custodial or non-custodial.

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Youth Ages 18–24

Young adults between the ages of 18 and 24 who are part of a low-income household.

Moving Stones SSF Eligibility and Intake Application

1. Applicant Information

First Name

Date of Birth

Email Address

Phone Number

Street Address

City

State

Zip Code

Residency & Work Authorization

Do you currently live in Tarrant County?

What is your current ZIP code?

⚠️ Note: This program is designed for Tarrant County residents. Please contact us at 817-898-8093 to discuss your eligibility before continuing.

Do you have the legal right to work in the United States?

Are you currently in the U.S. on a work visa?

⚠️ Note: This program is designed for Tarrant County residents. Please contact us at 817-898-8093 to discuss your eligibility before continuing.

Visa / Work Authorization Type

Visa / Work Authorization Expiration Date

Program / Training Applying For

Referred By

Do you need assistance with childcare?

Would you like to be referred for childcare assistance through Child Care Associates (CCA)?

Ages of Dependent Children

Do you need assistance with transportation to participate in training?

Would you like to be referred for possible transportation assistance through TWC or Workforce Solutions?

Current Employment Status

Highest Education Completed

Please note: For EKG and Phlebotomy a high school or GED is required. For CNA, must have 8th grade or better education. Would like to referred to GED resources?

What's your best education grade?

Are you currently enrolled in school?

Do you have healthcare experience

What field are you studying?

2. Eligibility Self-Check — Select All That Apply

⚡ Which of the following describes you? (Check all that apply)

SNAP / TANF / Public Assistance

I currently receive food stamps, cash assistance, WIC, CHIP, or another public benefit.

Low Income + Dependent Child

II earn less than $37,000/year and have a dependent child (custodial or non-custodial).

At Risk of Needing Public Assistance

I am unemployed, underemployed, or my income is not stable enough.

Youth Ages 18–24

I am between 18 and 24 years old and part of a low-income household.

Income Reference (~200% Federal Poverty Level)

Household Size	Annual Income Limit	Household Size	Annual Income Limit
1 person	$30,120	5 people	$73,160
2 people	$40,880	6 people	$83,920
3 people	$51,640	7 people	$94,680
4 people	$62,400	8+ people	$105,440+

Household Size	Annual Income Limit
1 person	$30,120
2 people	$40,880
3 people	$51,640
4 people	$62,400
5 people	$73,160
6 people	$83,920
7 people	$94,680
8+ people	$105,440+

Select Income Reference (Based on the table above)

3. Demographics — Equal Opportunity Reporting (Voluntary)

The following fields are collected for Equal Opportunity and federal reporting purposes only. Completion is voluntary and will not affect eligibility.

Gender Identity (optional)

Primary Language Spoken at Home

Is English your second language?

Have you attended ESL courses or currently enrolled?

Would you like to be referred to ESL classes?

Special Population (check all that apply)

Veteran or Active Military

Single Parent / Head of Household

Individual with a Disability

English Language Learner

Formerly Incarcerated

Foster Care Youth (current or former)

Homeless or At Risk of Homelessness

None of the Above

4. Documentation Checklist

Check all documents you currently have available to bring to your in- person interview.

Government-Issued Photo ID

Driver's license, state ID, or passport

Social Security Card

Driver's license, state ID, or passport

Proof of Residence

Utility bill, lease, or official mail (within 60 days)

High School Diploma, GED, or Transcript

8th grade or higher accepted

Proof of Income

Pay stubs (last 30 days), tax return, or employer letter

Proof of Public Assistance

SNAP, TANF, WIC, or CHIP award/benefit letter

Birth Certificate

Applicant and/or dependent children if applicable

Proof of Dependent Child

Required for $37,000 income-based eligibility

Veteran's DD-214

If applicable — discharge paperwork

Disability Documentation

If applicable — verification letter or medical record

5. Authorization

By submitting this application, I certify that all information provided is true, accurate, and complete to the best of my knowledge. I understand that providing false or misleading information may result in immediate disqualification from the Self-Sufficiency Fund program and may subject me to penalties under applicable state and federal law. I authorize Moving Stones and the Texas Workforce Commission to verify any information provided herein and to share relevant data for program administration and reporting purposes. I acknowledge that completion of this intake form does not guarantee enrollment, approval, or funding. I further acknowledge that this program is administered in compliance with Equal Opportunity requirements and that I will not be discriminated against on the basis of race, color, religion, sex, national origin, age, disability, or political affiliation.

Program Authority & Legal Notice — Texas Labor Code §309.002 | TWC Chapter 835 | SB 770, 87th Texas Legislature
Moving Stones administers this program in partnership with the Texas Workforce Commission (TWC) under Texas Labor Code §309.002 and TWC Chapter 835, as amended by SB 770 (87th Texas Legislature).
The Self-Sufficiency Fund (SSF) is administered by the Texas Workforce Commission (TWC). Moving Stones operates as an authorized program partner. Eligibility is limited to individuals identified as low-income or at risk of becoming dependent on public assistance per TWC Chapter 835. Completion of this intake form does not guarantee enrollment or funding. All information is subject to verification. False statements may result in disqualification. Equal Opportunity Employer/Program — Auxiliary aids available upon request. Form SSF-121 · 2/2026.