Section 3 Interest Form(Exhibit A for Workers)

First Name*

Last Name*

Email Address*

Phone Number*

County*

Income Level*

You may qualify as a Section 3 worker if your income for the previous or annualized calendar year is at or below 80% of the current area median income for the area in which the worker resides. The annual income limit is based on the worker’s income for a single person household (household of 1) regardless of actual household size.

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