Finish Line Grant
Preliminary Application and Agreement
State:
Phone:
Are you a veteran? No
Pre-Screening Questions:
Employment Status: Full-time Part-time Unemployed
If unemployed, have you worked in the last 6 mths? No Yes
Marital Status: _________________ Family Size: ______ Family Income (last 6 mths): _____________________
N/A
NoSelective Service (Males Only): Please check here if you are compliant with Selective Service: Yes I
I hereby verify that I am a United States Citizen or eligible to work in the United States: Yes
No
Are you registered in NCWorks? No Yes If yes, NCWorks ID
#: ______________________
Please describe in detail why emergency funds are needed. DOCUMENTATION MUST BE ATTACHED. If your
documentation is incomplete or does not support your request, your application will be denied (use back of form
if necessary).
My signature below indicates my attestation that the information provided on this form is accurate to the best of my
knowledge and that I understand more information may
be needed in determining eligibility for the funding.
Student Signature:__________________________________________________ Date: __________________
For Official Use Only – Wake Technical Community College
Academic Major/Course of Study (actively pursuing):
Type of Program (Please check one): Certificate Degree Diplom
a
Total Hours Completed: Total Hours Required for Program Completion:
Student is in good academic standing: Yes No Percent Completed/Enrolled In: ___________________
Comments: _______________________________________________________________________________________
_________________________________________________________________________________________________
Wake Tech Official Signature: ______________________________________________ Date: ___________________
For Official Use Only – Capital Area Workforce Development
Approved for Amount: $_______________ Denied (circle if denied – provide reason in comments below)
Comments:
Gender: Male Female
Zip Code:
First Name:
SSN (Last 4 Numbers):
Email Address:
Street Address:
City:
Date of Birth:
Student ID:
Middle Initial:
Last Name:
XXX-XX-
Yes
CAWD Official Signature: __________________________________________________ Date: ___________________
V5 11/08/2019
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