Workforce Funding and Support Programs Application

PERSONAL INFORMATION SECTION: For questions/items that do not apply to you please write N/A in that field.

Legal Last Name:(Required)

Legal First Name:(Required)

Preferred Name:(Required)

GHC Student ID # (NOT Your SSN):(Required)

Phone:(Required)

Email:(Required)

Date of Birth:(Required)

Mailing Address:(Required)

Street Address Address Line 2 City State ZIP Code

Are you a Veteran?:(Required)

Are you Washington State Resident for more 1 year?:(Required)

Are you currently receiving services from any of the following?:(Required)

Please select all that apply

TANF

Basic Food Assistance

Unemployment

Social Security Benefits

Tribal TANF

N/A

Are you seeking an Early Achievers Grant to pursue and Early Childhood Education Certification to maintain current employement?:(Required)

Total Monthly Income:(Required)

Number of people in your household:(Required)

Persons in Household	200% Poverty Guidelines Annual	200% Poverty Guidelines Monthly
1	$27,180	$2,265
2	$36,620	$3,051
3	$46,060	$3,838
4	$55,500	$4,625
5	$64,940	$5,411
6	$74,380	$6,198
7	$83,820	$6,985
8	$93,260	$7,771
Add for each person over 8 people:	$9,440	$786

Education Information: For questions/items that do not apply to you please write N/A in that field.

Program of Study:(Required)

Select Starting Quarter:(Required)

Are you a Running Start Student?:(Required)

Estimated Program Completion Date?:(Required)

This is your best guess based on the length of your program.

Are you a Currently registered GHC student?:(Required)

Do you hold a previous degree or certificate?:(Required)

Previous degree or certificate name?:(Required)

Employment Information: For questions/items that do not apply to you please write N/A in that field.

Current Employment Type:(Required)

Current Employer:(Required)

Hours Per Week:(Required)

Wages Per Week:(Required)

If None, Name of Last Employer:(Required)

Position Held:(Required)

Have you received unemployment benefits in last 48 months?:(Required)

Were you self employed within the last 24 months?:(Required)

Have you been terminated, laid off, received notice of termination, and are unlikely to return to your usual occupation?:(Required)

Financial Assistance Information: For questions/items that do not apply to you please write N/A in that field.

Have you applied for Financial Aid?:(Required)

Which of the following is most likely to prevent you from being successful at school: Please check all that apply:(Required)

Please Select All That Apply:

Lack of Tuition Funding

Lack of Textbooks

Lack of Childcare

Lack of Housing

N/A

Please tell us about why you are seeking our support at this time:(Required)

Additional Information: For questions/items that do not apply to you please write N/A in that field.

PLEASE READ THIS SECTION CAREFULLY:

Please Select All That Apply to You.

I have been providing unpaid services to family member(s) in the home.

I was dependent on the income of another family member but no longer supported by that income.

I am unemployed or underemployed and experiencing difficulty obtaining or upgrading employment.

N/A

Ability To Benefit:

ATB is for students who have not completed a High School credential (GED or Diploma) but would like to have access to financial aid and are academically ready to take non-high school classes. In addition to participating in an eligible career pathway program, students can become eligible for ATB by passing an approved test or successfully completing six college level credits. ATB allows a student to work on completing high school while receiving financial aid and moving forward on a career path.

Would you like to be considered for this program?

Do you already know about this program?

N/A

AUTHORIZATION FOR RELEASE OF INFORMATION(Required)

GHC staff adheres to Family Educational Rights and Privacy Act (FERPA) regulations regarding the privacy of student information. The information you give us is confidential. Your signature certifies that the information you provided is to the best of your knowledge. It also authorizes GHC staff to share information.

Date(Required)

Consent to Virtual Signature(Required)

I agree.

CAPTCHA

Continuous Non-Discrimination Notice

Grays Harbor College does not discriminate on the basis of race, color, national origin, sex, disability, sexual orientation, creed, religion, marital status, veteran status, genetics, or age in its programs, activities, and employment. The following person has been designated to handle inquiries regarding the non-discrimination policies: Title II/Section 504 Coordinator Darin Jones, Chief Executive of Human Resources Grays Harbor College 1620 Edward P. Smith Drive Aberdeen, WA 98520 360-538-4234 Title IX Coordinator Darin Jones, Chief Executive of Human Resources Grays Harbor College 1620 Edward P. Smith Drive Aberdeen, WA 98520 360-538-4234

Name

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