Fillable Workforce Education Center (Columbia Basin College)

Fill Online, Printable, Fillable, Blank Workforce Education Center (Columbia Basin College) Form

Use Fill to complete blank online COLUMBIA BASIN COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Workforce Education Center (Columbia Basin College)

On average this form takes 21 minutes to complete

The Workforce Education Center (Columbia Basin College) form is 3 pages long and contains:

  • 1 signature
  • 12 check-boxes
  • 73 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Columbia Basin College

BROWSE COLUMBIA BASIN COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Workforce Education Center
Childcare and Travel Reimbursement
Columbia Basin College 2600 N. 20
th
Avenue MS-H2 Pasco, WA 99301
cctandloanprogram@columbiabasin.edu
Phone: 5
09.544.4981
Date Stamp
Please fill out this section completely. The SID is your CBC Student ID number. Submitted
applications
are processed on a first-come/first-served basis. Incomplete applications will
take longer to process. Submit completed applications to cctandloanprogram@columbiabasin.edu.
Name (please print)
SID
Mailing Address
City State Zip
Physical Address
City State Zip
Home Phone Cell Phone
Date of Birth CBC Student Email
Emergency Contact Person Phone
REQUESTED ASSISTANCE:
Travel Expense Reimbursement
Childcare Reimbursement
Financial Aid
• In the Financial Aid Portal under the section “Information We Need From You” is a
list of paperwork required to complete your financial aid file. Double-check that all
paperwork has been turned in.
• If you have any questions about your financial aid, please speak with Hawk Central.
• Checkmark below to indicate your current status:
Financial Aid completed and submitted
Did not apply
Not eligible for Financial Aid
ABE
ESL
GED Running Start
Other:
Enrollment
Submit enrollment plans for academic year _________________. Provide number of
credits per quarter you plan on taking.
FALL
WINTER
SPRING
SUMMER
Revised 6/24/20
2
FOR STUDENTS REQUESTING CHILDCARE REIMBURSEMENT
Incomplete or inaccurate information will delay approval.
1. Do you receive childcare assistance from any other agency?
Yes No
Agency Name: _________________
If yes, what is your monthly out of pocket expense: $____________
2. Number of children assistance requested for:
Name:
Name:
Name:
Name:
Age:
Age:
Age:
Age:
3. Childcare Provider Information
Provider Name:
Address:
Phone Number:
Email:
Contact Name:
Cost Per Month:
Consent to Release Childcare Information
I consent to the use of confidential information about me with Columbia Basin College to
verify enrollment and costs of childcare for the purpose establishing eligibility in the CBC
Childcare Reimbursement program. I further grant permission to CBC to verify the above
information quarterly for the academic year ________.
Student Signature: _____________________________ Date: ___
Print Name: __________________________
click to sign
signature
click to edit
FOR STUDENTS REQUESTING TRAVEL REIMBURSEMENT
1. Please provide class information for courses that require you to travel (i.e. attend class, attend lab,
or practicum).
2. Valid driver’s license and valid insurance is required. Contact program administration to
submit proof of license and insurance (cctandloanprogram@columbiabasin.edu).
3. I verify that this assistance reimburses my costs for driving to and from
class/lab/practicum. Initials _______
I understand that my eligibility for the above programs will be verified through access to my CBC
student information including Financial Aid, academic records, and other student support services. I
will provide other information as requested from the program administrator as needed to verify
eligibility. I understand that the Workforce Education Center reserves the right to cancel assistance if
necessary information is not provided.
I certify the above is true and accurate to the best of my knowledge. I understand that
such information is subject to verification and further understand that the above
information, if misrepresented or incomplete, may be grounds for immediate termination
from any/all of the Workforce Education Center programs.
Date:
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title I X, equal opportunity and affirmative action. CBC
does not discriminate on the basis of race, color, creed, religion, national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or
expression, age, genetic information, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal
(allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Questions or complaints may be referred to the Vice President for Human
Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548.Individuals with disabilities are encouraged to participate in all college sponsored events and programs. If you have
a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in
alternative media by request.
Item #
Course ID
Day
Time
Class/Lab/Practicum Location
9901
TRA387
T Th
5AM – 6AM
T246
Submit completed applications to cctandloanprogram@columbiabasin.edu.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Workforce Education Center (Columbia Basin College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 28 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document