VCEDA/Non-Credit Financial Aid Application General InformationStudent ID:(Required) Date(Required) MM slash DD slash YYYY Applicant Name:(Required) First Middle Last Former Name: First Middle Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country SSN:(Required) Date of Birth: MM slash DD slash YYYY Gender(Required) Male Female Phone(Required)Alternate Phone:Email(Required) Please attach copies of the following eligibility documents required for qualification for Continuing Education Financial Aid:Citizenship Status - for non-U.S. citizens, please provide visa or other proof of status for review(Required) Drop files here or Select files Max. file size: 50 MB. U.S. Citizen, Permanent Resident, or Political Asylum/RefugeeTemporary Visa: Please specifyOther: Please specifyProof of Virginia Residency-Must provide one of the items below to show Virginia residency for one year(Required) Drop files here or Select files Max. file size: 50 MB. Utility Bill, Housing Contract, Voter Card, Rent Receipt, Preprinted Bank Statement, or Driver’s LicenseAge Verification - Must be at least 18 years of age or older OR completed high school graduation requirements.(Required) Drop files here or Select files Max. file size: 50 MB. Driver’s License, Birth Certificate, State-Issued ID, Passport, High School Transcript, High School DiplomaCompliance with Military Selective Service Act (male students only) Yes No I am in compliance with the Selective Service Act requirements.Highest Level of Education (select all that apply)(Required) No High School Diploma/GED GED High School Graduate Some college no degree Associate’s Degree Bachelor’s Degree Master’s Degree Doctoral Degree Are you currently enrolled in an Associate or Bachelor’s degree program?(Required) Yes No Please provide documentation that the training relates to the degree program and is necessary to meet a job requirement or advance employment success. Drop files here or Select files Max. file size: 50 MB. Have you ever received an industry credential?(Required) Yes No Please specify: Drop files here or Select files Max. file size: 50 MB. Are you eligible for other tuition assistance benefits?Are you a veteran who is eligible for GI Bill funding?(Required) Yes No Are you currently employed?(Required) Yes No If you are employed, have you been laid off in the last 20 months and is your current job an interim or temporary position?(Required) Yes No Are you or will you be receiving any other tuition assistance for this program from other sources?(Required) Yes No Specify below which program: Workforce Innovation & Opportunity Act (WIOA) Virginia Initiative for Employment Not Welfare (VIEW) Department of Aging & Rehab Services Federal or State Financial Aid Other Which program: Are you eligible for SNAP (Supplemental Nutrition Assistance Program) or TANF (Temporary Assistance for Needy Families)?(Required) Yes No Please provide one of the followingMax. file size: 50 MB.Current SNAP Card, Current TANF Card or Documentation stating eligibility for either SNAP or TANFHousehold IncomeIs anyone claiming you as a dependent on their tax return?(Required) Yes No Household Income (If hourly – Rate of Pay per hour X Hours Worked per year)(Required) Number of persons in family/household(Required) Applicant submitted Tax Transcript verifying household income.(Required) Yes No Additional Information for Clarification:Application Checklist - check below to indicate that you have provided each of the following items:(Required) Completed each item on this form If necessary, provided documentation of eligible noncitizen status Attached documentation confirming Virginia residency Attached documentation of age or high school completion If applicable, attached documentation of SNAP or TANF Attached a copy of Most Recent Tax Return/W2’S and most recent pay stubs/or Most Recent Tax Transcripts By signing this form, I agree to provide a copy of the credential awarded upon the completion of all required coursework and/or certification test. I certify that the information in this application is true and complete to the best of my knowledge and, if I later determine any information in this application to be represented incorrectly, I will contact the Continuing Education Office.Student SignatureDate MM slash DD slash YYYY Program CoordinatorDate MM slash DD slash YYYY WFD SupervisorDate MM slash DD slash YYYY
