Date Term Piratemail (Prefix Only) Student I.D. Program of Study
I am working towards (check box that applies) Associate of Science Vocational Certificate
Last Name First Name M.I. Birth Date
Ethnicity (optional) Gender Do you have any dependents?
Yes
No
If yes, how many?
Marital Status
Single
Separated
Divorced
Widowed
Married
Married, Spouse Disabled
Name(s) and Age of all minor children:
Current Address
Street Address
City
State
Home Phone
Number
Employment
Status
Full-Time
Part-Time
Not Employed
Secondary
Education
High School
Received GED
Less than 12 Years
Zip Code
Address 2
Cell Phone
Number
None
Some
Completer
A.A. /A.S. Degree
Baccalaureate Degree
Master's Degree
None
Pensacola State College Career and
Technical Education Student
Application
Please include a copy of your current class schedule and financial aid award letter printed from your Spyglass.
account.
Male
Female
Post-Secondary
Education
Vocational
Education
Some
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
Please fill out this form in its entirety and submit a copy of your PAID schedule for term 20191. This form may only be
submitted once and no schedule changes will be accepted. Please be sure that attached, is a copy of your final schedule. You
must be a current CTE student for your book request to be considered. Please type in the form, then print and sign below. Book
Requests are due no later than November 26, 2018, end of business. No late forms will be accepted.
Contact Information
First Name Last Name
Piratemail Student ID#
Cell Phone number Home Phone Number
Best method for contacting you? Best time of day to reach you?
CTE can no longer buy books for General Studies Courses. (i.e. English Comp 1, Algebra, etc.) You will be contacted by your
method of choice and have two business days to pick up your materials or they will be forfeited. Filling out this form does not
guarantee fulfillment of your book request. Book requests are granted on a first come/first serve basis. If you have any questions,
please contact Career and Technical Education.
Signature
By signing this form, you understand and accept all conditions.
Approved
Staff Member
Career and Technical Education
Book Scholarship & Loan