• Southeastern Community College

    PACE/GAP Application

  • Please Note:   Applications received a week or less prior to training start date may not have sufficient time for approval process.

     

  • APPLICANT INFORMATION

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • What is your marital status?*
  • Check all that apply:*
  • Are you working with any other agency?*

  • Personal Information

    Include income from spouse and any one else that is residing with you that you are related to by blood, marriage, or decree of court in the following questions:
  • Which of the following best describes your employment status?*
  • Please list name of everyone and relationship to you that lives with you.*
    Rows
  • What are your primary sources of income?*
  • Are you receiving any additional assistance?*
  • Do you have primary responsibility for supporting the individuals in your household?*
  • Are you homeless?*
  • If yes, do you live in a shelter?
  • Do you have a current driver's license?*
  • Do you have access to a reliable car?*

  • Work History (Present or Most Recent)

    All information for work history is required for each job you list. This includes employer, job title, start/end dates, job description, and reason for leaving. 

  • Start Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date (if current, leave blank)
     - -
    2 digit month, 2 digit day, 4 digit year
  • Current Employer?*

  • Work History Continued

    All information for work history is required for each job you list. This includes employer, job title, start/end dates, job description, and reason for leaving.

  • Start Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date (if current, leave blank)
     - -
    2 digit month, 2 digit day, 4 digit year
  • Current Employer?

  • Work History Continued

    All information for work history is required for each job you list. This includes employer, job title, start/end dates, job description, and reason for leaving.

  • Start Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date (if current, leave blank)
     - -
    2 digit month, 2 digit day, 4 digit year
  • Current Employer?

  • Education

  • Last grade level completed*
  • High School Diploma or Equivalent (GED/HISET) completed?*
  • Are you currently a student?*
  • Other training certificate or credential earned*
  • Have you previously attempted a non-credit or credit (diploma/degree) program here at SCC?*
  • If yes, did you complete?
  • Do you have a National Career Readiness Certificate (NCRC)?*

  • Request Summary

  • Are you willing to relocate for work?*
  • Have you applied for PACE or GAP assistance through any Iowa community college before?*
  • What would you consider to be your barriers for success right now? Check all that apply.*
  • Have you been convicted of a felony?*
  • How did you hear about this assistance?*

  • *If you select "text" as best way to reach you, you will be asked to "opt in" before SCC can contact you. Please watch for a text asking for you to "start to receive text messages from Southeastern Community College"

  • Applications received a week or less prior to training start date may not have sufficient time for approval process. 

    I certify the information I have provided during this application process is true to the best of my knowledge. 

    I agree to provide all of the proper documentation that is requested of me by Southeastern Community College staff for eligibility determination purposes.  I am also aware the information I provide may be reviewed and verified and that I may have to provide additional documents to support the information contained in this application.  By giving my signature below, I give my consent and permission for release of information by Southeastern Community College staff to partner agencies (Iowa Workforce Development, IowaWORKS, Department of Human Services) for documentation purposes and to gain further information for eligibility purposes.

    Further, I understand that this information will be used to determine my eligiblity for participation in the PACE and GAP programs, including consideration for tuition assistance, and the support services that the PACE program can provide.  I understand that each application is reviewed and approved on an individual basis and may not reflect what others have received. 

    I understand that eligibility for tuition assistance under this chapter shall not be construed as a guaranteed enrollment in any community college certificate program.

     

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: