YVC Special Funding & Individual Employment Plan

YVC Special Funding & Individual Employment Plan

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Todays Date*

Applying For*

Indicate what you are applying for. If you need to contact us about any of these programs, you can call 509-834-4599 or email specialfunding@yvcc.edu.

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Applicant Information

First Name*

Last Name*

Date Of Birth*

Social Security #*

SID*

Mailing Address*

City*

State*

Zip*

Phone*

WA State Resident For At Least 12 Months?*

Yes

Are You A U.S Citizen?*

Yes

Are You A Permanent Resident?*

Yes

Resident#

Employment Information

Are You Currently Employed

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Last or Current Employer*

Job Title*

First Day of Work*

Reason for Job Seperation*

Last Day of Work*

Financial Information

Are You Currently Receiving Any Of The Following?*

Select All That Apply

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Do you want to apply for Basic Food Employment and Training?

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What Is Your eJAS Cast#?

Are You Receiving College Tuition Assistance?*

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Tuition Assistance Being Received*

Grants, Scholarships, or Loans

Check All That Apply (Past 48 Months/4 Year)*

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Check All That Apply (Past 24 Months/2 Year)*

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Are You Working With Or Approved For The Following*

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Educational History

Have you applied for Financial Aid (FAFSA)?*

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DREAMers Completed WASFA?*

www.readysetgrad.org/WASFA

Education (Check All That Apply)*

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Certifications or Degrees Earned*

Colleges Previously Attended*

Educational Information

Program Of Study At YVC*

Program Advisors Name*

Date Of Last Meeting With Advisor?*

Are you enrolled in a Direct Transfer Agreement (DTA 999A) pathway?*

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What Degree or Educational Pathway are you enrolled in?*

How many credits are you enrolled in*

Interest And Career Goals

Strengths, Skills, Abilities, & Interests*

Please list any below that related to this career path and will help you reach your career goals.

Education & Career Goals Motivation*

What motivates you to achieve your educational and career goals?

What Obstacles Are Prevent Completion Of A Degree?*

Also indicate the steps you have taken to address these obstacles.

What are your Short-Term Goals (0-2 years)*

What are your Long-Term Career Goals (2+ years)*

Supportive Services and Needs

Needed Supportive Services*

Select All That Apply

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Academic Training Plan

Academic Training Plan*

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Academic Training Plan - Credits*

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Academic Year*

Program Of Study*

Current Transcripts

Academic Training Plan & Transcript Upload

Upload Academic Training Plan, Current and Past YVC Classroom Transcripts (Unofficial is Ok). Document should be in an excel file format and include the following information in each column: quarter attended, course #, credit per class, total quarter credits, and Grade Point Average (GPA) Example: Fall / ECED138 / 3 3 Total / 2.0 GPA

*Please contact your advisor if you need assistance with an Academic Training Plan

Drag and drop files here or

Self Attestation Form

Students who are dislocated workers, displaced homemakers, formerly self-employed, or eligible under the expanded eligibility or stopgap employment policies may self-attest to the information below.

Are you formerly self-employed, and no longer have work because of local economic conditions?*

(FORMERLY SELF-EMPLOYED)

Yes

Are you formerly self-employed, and no longer have work because of a natural disaster?*

(FORMERLY SELF-EMPLOYED)

Yes

Are You A Displaced Homemaker?*

(DISPLACED HOMEMAKER)

Yes

Are You Currently Unemployed?*

(DISPLACED HOMEMAKER or DISLOCATED WORKER)

Yes

Are you a displaced homemaker or have you previously been laid-off and are currently employed, but have a net income of less than 175% of the federal poverty level? If yes, complete the wage information below.*

(DISPLACED HOMEMAKER or STOPGAP)

Yes

Have you previously been laid-off and are now working a temporary job with wages at least 20% less than your customary job/work history.*

If yes, complete the wage information below. (STOPGAP)

Yes

Have you previously been laid-off and are currently employed in a position that is temporary in nature and only intended to support you as you complete training? Upon completion of your training program, do you intend to end this job for a position in line with your training program?*

(STOPGAP)

Yes

Have You Earned 45 College-level quarter credits?*

(EXPANDED ELIGIBILITY)

Yes

Have the minimum qualifications for your current position changed and training is necessary to maintain employment?*

(EXPANDED ELIGIBILITY)

Yes

Are you currently employed in a position that is no longer in demand?*

(EXPANDED ELIGIBILITY) Not sure if you qualify? Visit https://fortress.wa.gov/esd/employmentdata/ to learn more.

Yes

Wage Information

To determine eligibility, Displaced Homemakers and Opportunity Grant applicants NEED to complete the information in the section below for current income.

Current Income*

Net Income (Per Year)*

Prior Year Income*

Net Income (Prior Year)*

Household Size*

Number of People Living In Your Household

Basic Food Employment & Training BFE&T (Food Stamps) Program Student Guidelines

The following is your personal checklist to ensure you are successful here at YVC and are aware of the policies governing this program. Please initial that you have read and understand each item.

I understand that in order to participate in the BFE&T program. I must be receiving food assistance from DSHS and not be on TANF. I agree to turn in all paperwork requested by DSHS in order to keep my food benefits open. My basic food benefits must be open each quarter in order for me to receive BFE&T assistance.*