Ticket To Work Form

Fill out the Ticket To Work application, and a representative will be in touch with you soon.

"*" indicates required fields

Name*
Address*
Email*
Date of Birth*
Are you currently working?*
Have you ever been convicted of a felony?*
Have you worked with another EN or state Vocational Rehabilitation Agency?*
Do you have access to reliable transportation in order to commute to a job?*
Date SSA awarded Disability*
HIghest Level of Education:*
Please check ALL of the benefits you are receiving:*
Are you currently receiving SSDI or SSI monthly cash benefits?*
Please check the services that will help you reach and maintain your employment goal:*
This field is for validation purposes and should be left unchanged.

Ticket to Work Program

The Ticket to Work Employment program is a free and voluntary program that can help all individuals who receive Social Security Disability Income (SSDI) or Supplemental Security Income (SSI) feel good about themselves, find employment that may lead to a career, and become self-sufficient.

Learn More