2023 JCCC CE Training Award Application

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2023 JCCC CE Training Award Application

First Name

Middle Name

Last Name

JCCC ID (if applicable)

Residential Street Address

City

State:

ZIP

Phone Number

Date of Birth

Gender:

This project is being supported by federal award number SLFRP0226 awarded to Johnson County, Kansas, by the U.S. Department of the Treasury. As part of the reporting requirements for that award, JCCC is collecting the following demographic information:

Ethnicity:

Race:

Veteran Status:

Are you a foster youth or were you at any time in the foster care system?

Please provide a brief explanation of how this program/these courses will help you reach your employment goal:

Please select the documentation you will be providing to verify proof of eligibility:

FAFSA EFC Score Cover Page (14000 or less)

Proof of annual salary of $45,000 or less (recent paystub)

Proof of unemployment (Documentation from Unemployment Office or Termination letter from employer)

By submitting this application I attest that the following is true and agree to the terms of the award:

I attest that I am actively seeking employment or improved employment and the information stated above is true and accurate.

I acknowledge that I must complete all online classes that I register for, and that I must access all online classes within 1-week of receiving class access information.

I acknowledge that I must attend and complete all in-person and live online classes that I register for.

I understand that I must reply to any surveys that I receive regarding this funding program and my current employment status as requested.

I understand that failure to comply with these terms may be grounds for termination from the program, removal from courses, and/or prevent my enrolling in additional classes or receiving additional funding.

I authorize JCCC to share my Academic Records and Account Information with the Johnson County Government, which provided the funding for the CE Training Award. This authorization applies only to course enrollments paid for by the CE Training Award.

Applicant Name:

Date:

Nondiscrimination Statement: JCCC provides equal opportunities and equal access to all individuals and is an affirmative action employer. JCCC does not discriminate on the basis of sex, race, color, national origin, ancestry, disability, age, religion, marital status, parental status, military status, veteran status, sexual orientation, gender identity, genetic information or other factors that cannot be lawfully considered in its programs fand activities, which includes employment and admissions, in accordance with Titles VI and VII of the Civil Rights Act of 1964, the Equal Pay Act of 1963, the Age Discrimination in Employment Act of 1967, the Age Discrimination Act of 1975, Executive Order 11246, Title IX of the Education Amendments of 1972, Section 503 and 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act, the Vietnam Era Veteran’s Readjustment Assistance Act, the Jobs for Veterans Act of 2002, the Kansas Acts Against Discrimination and all other applicable civil rights and nondiscrimination laws.

Inquiries concerning JCCC's compliance with its nondiscrimination policies (including Title IX, Title VI and Section 504 inquiries) may be referred to a Title IX Coordinator (TitleIX@jccc.edu), or Director of Human Resources, or the Dean of Students and Learner Engagement at Johnson County Community College, 12345 College Blvd, Overland Park, KS 66210, 913-469-8500; or to Office for Civil Rights, Kansas City Office, U.S. Department of Education, One Petticoat Lane, 1010 Walnut Street, Suite 320, Kansas City, MO 64106, Telephone: 816-268-0550, Facsimile: 816-268-0559, Email to: OCR.KansasCity@ed.gov.

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