Grays Harbor College (GHC)
Workforce Funding and Support Programs Application
2
What is your program expected end date? Month_________ Year________
Are you a currently a registered GHC student? Yes No
Have you completed a college degree or certificate? Yes No
College degree or certification(s) obtained _____________________________________________________
EMPLOYMENT INFORMATION SECTION:
Current Employment: Part-time Full-Time None
Current Employer: ___________________________________________________________________________
Hours per week: __________________________ Wage per hour $: ____________________________________
Employer of last job held ___________________________________ Position: ___________________________
Have you received unemployment benefits within the last 48 months? Yes No
Have you been terminated, laid off, or received “notice of termination or layoff” and are unlikely to return to your
usual occupation or industry? Yes No
Were you self-employed within the last 24 months? Yes No
FINANCIAL ASSISTANCE INFORMATION
Have you applied for Financial Aid? Yes No
Which of the following is most likely to prevent you from being successful at school: Please check all that apply:
Lack of tuition funding Lack of textbooks Lack of Childcare Lack of Housing
Please tell us about why you are seeking our support at this time:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
AUTHORIZATION FOR RELEASE OF INFORMATION
GHC staff adheres to Family Educational Rights and Privacy Act (FERPA) regulations regarding the privacy of
student information. The information you give us is confidential. Your signature certifies that the information you
provided is to the best of your knowledge. It also authorizes GHC staff to share information.
Student Signature: _________________________________________ Date: _________________________
(Virtual signature
) By checking this box, I agree that I have reviewed and complete this IEP with the student.
