Annual Family Income
$0-$5,000
$5,001-$10,000
$10,001-15,000
$15,001-20,000
$20,001-or more
Income Source
Employment
WAGES (Work and Gain Economic Self-Sufficiency)
Social Security/SSI
Unemployment
Alimony
Other
Do you receive any of the following?
Food Stamps
Escarosa/WIOA(Workforce Innovation and Opportunity Act)
Child Support
WIC (Woman Infants and Children
Vocational Rehabilitation
Pell
Grant
Before you can be set-up for an appointment with a CTE counselor, you must sign up for employPSCstudents ,
the student job board.
I certify that the above information is true and correct.
Type your student ID # then print completed form.
I’m interested in the following services offered by Career and Technical Education Student Resources.
Book loans
Scholarships
Cooperative Education and Internships
Job Placement
Employability Skills and other counseling services
If you meet eligibility requirements to receive services, you must sign the attached form completely to receive a
book loan or scholarship. You must include a copy of your PAID current class schedule, and a list of textbooks
that are required for your scheduled courses.
(Check all that apply.)
(Check all that apply.)
Vocational Rehabilitation
Other