Fillable Application for Services WORKER RETRAINING, WORKFIRST, OPPORTUNITY GRANT (Spokane Community College)

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Application for Services WORKER RETRAINING, WORKFIRST, OPPORTUNITY GRANT (Spokane Community College)

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The Application for Services WORKER RETRAINING, WORKFIRST, OPPORTUNITY GRANT (Spokane Community College) form is 2 pages long and contains:

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  • 8 check-boxes
  • 50 other fields

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File type: PDF

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Page 1 of 2
CCS 40-198 07-19
Marketing and Public Relations
Application for Services
WORKER RETRAINING, WORKFIRST, OPPORTUNITY
GRANT AND BFET
SCC SFCC
Name:
Date:
(Last)
(First)
(MI)
Address:
(Number and street)
(City)
(State)
Phone:
( )
/
( )
(Day)
(Cell)
E-mail address:
Social Security #:
Student ID #:
Have you lived in Washington state for 12 months or longer?
Yes No
Have you applied for financial aid (FAFSA)?
Yes No
Current number of people you financially support in your household:
What support are you hoping to receive?
EDUCATIONAL INFORMATION
Course / program of study:
Degree Program Certificate Program Non-credit Other
Are you currently taking prerequisites?
Yes No
Previous education obtained (note all that apply)
a. Degree(s):
b. Certificate(s):
c. Other education and training?
EMPLOYMENT HISTORY
Are you collecting unemployment?
Yes No
Have you collected or exhausted unemployment anytime in the last 48 months?
Yes No
Are you currently employed?
Yes No
Are you formerly self-employed?
Yes No
Is your employer requiring more training or skills to keep your position?
Yes No
Have you been separated from the military within the past 48 months?
Yes No
Are you active military with an order of separation?
Yes No
Displaced homemaker: Has been dependent on the income of a household member and
is no longer supported by that income within the last 48 months; and is low-income and
unemployed or underemployed.
Yes No
Page 2 of 2
CCS 40-198 07-19
Marketing and Public Relations
FUNDING INFORMATION
Have you received Opportunity Grant funding at any other Washington State community
or Technical college?
Yes No
Are you receiving funding from (check all that apply)?
Department of Vocational Rehabilitation (DVR)
Veterans / GI Bill®
Basic Food Assistance (DSHS)
WorkFirst/TANF – JAS ID:
Trade Adjustment Assistance (TAA)
Other:
AUTHORIZATION FOR RELEASE OF INFORMATION
We adhere to FERPA regulations regarding the privacy of student information. The information you give us
is confidential. We will share it with our WorkSource partners in order to give you access to employment
and training services. Partners typically include Employment Security, the Department of Social and Health
Services, the Division of Vocational Rehabilitation, Community Colleges of Spokane, and others. Your
signature authorizes this release of information and certifies that the above information, including college
academic status and class attendance, is true and correct to the best of your knowledge. Your signature
also indicates your acceptance of available Workforce Education funding. Future Workforce Education
funding is contingent on satisfactory academic progress and continued eligibility.
Student signature
Date
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Application for Services WORKER RETRAINING, WORKFIRST, OPPORTUNITY GRANT (Spokane Community College)

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Completed 8 October 2020

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