Fillable Arkansas Career Pathways Initiative Data Update National Park (National Park College)

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Arkansas Career Pathways Initiative Data Update National Park (National Park College)

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The Arkansas Career Pathways Initiative Data Update National Park (National Park College) form is 2 pages long and contains:

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  • 3 check-boxes
  • 41 other fields

Country of origin: US
File type: PDF

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Arkansas Career Pathways Initiative Data Update
National Park College
The following information is requested to re-verify eligibility to participate in the Career Pathways
Initiative (CPI).
Please Print Date:
Name: Maiden Name:
Address: City: Zip: County:
Phone: Alternate Phone: Emerg. Contact Phone:
Social Security: Birthdate:
Email:
Are you a single Parent? ☐Yes ☐
No
Do you currently receive:
TEA:
☐
Yes
☐
No
Are you a former recipient of TEA:
☐
Yes
☐
No
Food Stamps:
☐
Yes
☐
No
AR Kids:
☐
Yes
☐
No
Medicaid
☐
Yes
☐
No
Current Employment Status:
☐
Part-time
☐
Full-time
☐
Unemployed
Name of Employer:
Your monthly salary:
Time with Employer in months:
By signing below, I give full permission to the CPI staff at National Park Community College to review my financial and
academic records including but not limited to my FAFSA application, income tax return, if requested, test scores,
transcripts, and participation with DHHS programs. This information will be used to re-verify my eligibility to
participate in CPI. The program may also access pertinent records related to my employment and
attendance/graduation.
Also, by signing below, I verify that I am a parent, with a child under the age of twenty-one who lives with me in my
residence, on a full time, permanent basis.
By signing below, I understand I will not be eligible for monetary services if my grade point
average is below or falls below 2.0.
Signature
Date
Revised 8/15
click to sign
signature
click to edit
Please provide the names and Date of Birth(DOB) of all your children currently living with you:
Childs Name: DOB:
Childs Name: DOB:
Childs Name: DOB:
Childs Name: DOB:
Childs Name: DOB:
Childs Name: DOB:
Revised 8/15
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Arkansas Career Pathways Initiative Data Update National Park (National Park College)

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Completed 28 January 2021

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