1 Revised 6.8.2020
SHORT-TERM TECHNICAL
CERTIFICATE GRANT APPLICATION
To be eligible for this grant, you must:
1. Complete this application
2. MUST declare a major from ONLY the list below
3. Submit this application with the Short-Term Certificate Program registration/enrollment form
This grant pays for tuition and fees only
This grant only pays for courses that are part of an approved certificate program (see below)
The maximum amount a student may receive is $4,000, if eligible, per lifetime
The awarding of this grant is conditional upon the continuance of state funding
Please provide the following information:
Student Name: Student ID:
Date of Birth: Phone:
Are you 25 years of age or more? Yes________ No _________
Term Applying for Short-Term Grant: Fall_____ Spring _____ Summer_____ 20_____
Check a box next to your declared major at Edison State:
Approved Short-Term Technical Certificate Programs
Accounting Clerk
Human Resource Management
Advanced Manufacturing Systems
Industrial Electrical Controls
Banking Fundamentals
Lean Manufacturing
Basic Electricity
Manufacturing Management
Basic Human Relations
Medical Scribe
Business Management
Phlebotomy
CNC Programming
Programming
Computer-Aided Design
Quality Management
Electronics Networking
Real Estate
Factory Automation
Supply Chain Management
Help Desk
Tax Consultant
Basic Peace Officer’s Academy
Software Tester
Print Reading and Controls
Basic Computer Skills
Emergency Medical Technician
Write a paragraph explaining your financial need: ________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Please sign application on page 2 where indicated.
2 Revised 6.8.2020
If I am awarded this grant, I agree to abide by all the conditions of this grant. I understand that if I fail to attend
my classes my grant disbursement will be removed from my account and I may be required to pay any resulting
balance due on my Edison State account.
I certify that, to the best of my knowledge and belief at the time and date I have signed below, all information
listed on this application is true and accurate.
Student Signature: Date:
I authorize Edison State Community College permission to release appropriate publicity upon the award of this
grant.
Student Signature: __ Date:
Submit Completed Application to:
Edison State Community College
Financial Aid
1973 Edison Drive
Piqua, OH 45356
financialaid@edisonohio.edu
OFFICE USE ONLY. DO NOT WRITE IN THIS SECTION:
Program Eligible Y N _ Multiple Active Programs: Y N Other Program: _______________________
Comments:_____________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Title IV Eligible: Y N _ FAFSA on File: Y N STG Eligible: Y N
Comments:_____________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Dean Y N _
Comments: _______________________________________________
______________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Grant Award Amount: $
Date Grant Awarded: __
To Financial Aid for notification
Copy to Dean
click to sign
signature
click to edit
click to sign
signature
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