Fillable Student App (Johnston Community College)

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Student App (Johnston Community College)

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The Student App (Johnston Community College) form is 2 pages long and contains:

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  • 11 check-boxes
  • 29 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Johnston Community College

BROWSE JOHNSTON COMMUNITY COLLEGE FORMS

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Johnston County Works
Student Application
Date: __________________
Applicant Name: _____________________________________________________________
Home Address: ______________________________________________________________
Home Phone: _________________________ Cell Phone: ___________________________
Email: ______________________________________________________________________
Employment Status: _____ Full Time _____ Part-time _____ Unemployed
Gender: _____ Male _____ Female
Race: _____ White _____ Black _____ Hispanic _____ Asian
_____ Native American/Indian Other: ____________________________________
Please check all that apply:
_____ Quota Holder _____ Former Quota Holder
_____ Family member of farmer
Please check below how you, or your family, has been adversely affected by the
decline of tobacco and agriculture industries.
_____ Tobacco related plant closing/layoff
_____ Farming related
_____ Other: ______________________________________________________
Please initial each statement as acknowledgement:
_____ I will make an appointment and work with JCC Career Services for career development
and placement.
_____ I will maintain contact with the Johnston County Works staff to provide career
placement information and outcomes.
Please mark your reason(s) for enrolling in Johnston County Works:
_____ Career Counseling _____ Training _____ Employment Placement
_____ Financial Assistance _____ Other: ________________________________
Please write a brief statement describing the impact this funding will make in
acquiring your educational and career goals.
Program/Course Title: ______________________________________________________
Course Code: ____________________________________
Class Begin Date: __________________ Class End Date: __________________
Books/Supplies required: ________________________________________________________
Approximate Total Cost: ___________________
Student Signature: ____________________________________ Date: ________________
Director of Program/Course: ____________________________ Date: ________________
Johnston County Works Authorization: ____________________ Date: ________________
Johnston County Works is funded through a grant provided by the NC Tobacco Trust Fund.
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Student App (Johnston Community College)

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Completed 29 July 2020

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