Receiving temporary assistance for needy families (TANF) DSHS client ID #
Need Childcare to aend classes?
YES NO
Program of study: Program Code:
Expected Compleon Date:
Highest level of educaon:
Less than high school High school/GED Some college Degree
Have you received Opportunity Grant from any other college? YES NO
If yes, where?
2020-2021 WORKFORCE EDUCATION FUNDING APPLICATION
Worker Retraining (WR), WorkFirst (WF), Basic Food Employment and Training (BFET), Opportunity Grant (OG).
You are applying for all special funding programs at Edmonds College.
Last Name:
SSN:
Street Address:
First Name: MI Initial:
Applicant Information:
Program Eligibility:
Check all the following that apply to your situation:
SID: Date of Birth:
City ZIP:State:
Phone: Email:
Collecng basic food
Collecng or exhausted
unemployment
Low income and interested in one of the following programs
(Allied Health, Early Childhood Education, Accounting, IBEST)
Displaced homemaker
(see coversheet for description)
Vulnerable worker
(see coversheet for description)
Self-employed, now unemployed
Veteran
Training and Program Information:
Signature Date
(found on program
requirement sheet)
Authorization Release:
We adhere to FERPA regulations regarding the privacy of student information. The information you give us is
confidential. Your signature authorizes Edmonds College to release any and all educational and financial information to
our partner agencies including WorkSource partners, Employment Security, the Department of Social and Health Services
(DSHS), community colleges, internal Edmonds College faculty/staff. I certify that this information provided is true to the
best of my knowledge. I also authorize Employment Security to release information to Edmonds College for the purpose
of determining eligibility for the Worker Retraining Program and to provide employment information.
MM DD YYYY
MM DD YYYY
quarter year
(If known)
2 year
4 year
