walmart brighter futures grant application

WALMART BRIGHTER FUTURES GRANT APPLICATION
Get on the right path toward your career as quickly as possible! If you are ready to complete the final class in one of our MyCareer Certificate of Completion programs, you have the opportunity to receive up to $500. Funds are provided through the
Walmart Brighter Futures Grant. Program ends December 18, 2015.
Tuition Award
(Maximum award: $500 per student per program)
• Enrollment in a class that completes a Certificate
of Completion at South Mountain Community
College
• Maintain a grade of “P” or “C” or better
• Maintain satisfactory attendance per South
Mountain Community college policy
• Apply prior to graduation
Test Certification Reimbursement Award
(Maximum award: $400 per exam)
• Test results must be completed and submitted
with the application and proof of payment
• Attended South Mountain Community College
after October 1, 2013
• Maintaining a grade of “P” or “C” or better and
satisfactory attendance OR be successful graduate of a South Mountain Community college
program
• Certification test must have been completed
between May 1, 2015 and December 18, 2015
Requirements
• U.S. Citizen or Legal Resident - must meet HB2008 requirements
• Currently are or have been a MyCareer student (currently enrolled or have graduated from South Mountian
Community College after October 1, 2013)
• Annual income is at or below $22,340.00 (self declared)
• 18 years of age or older
Please note: Due to limited funds, submission of application does not guarantee funds will be awarded. Any funds awarded to student account will apply toward any negative balance before being released to the student. Only those with a lawful presence in the U.S. may qualify
for Maricopa County Community College District scholarships or federal financial aid. Any information you provide about your legal status
when you apply for financial aid or scholarships may be subject to mandatory reporting to federal immigration authorities under Arizona law.
Your signature below verifies you understand all requirements and all information provided on this application is complete and accurate.
Student Information
Applicant Name (print):
Date:
Street Address:
Date of Birth:
City:
State:
Zip code:
Home #:
Cell #: Email:
Student ID:
Applicant Signature:
Annual Income: I am applying for the tuition award
I am applying for the test reimbursement
(Select your program below)
(Select all that apply)
⎕ Adobe Creative Suite in Business: Production
Applications Specialist
☐ Adobe Certified Expert: Photoshop (9A0-354)
⎕ Adobe Foundations
☐ CCENT Cisco Certified Entry Network Technician
(100-101 ICND1)
⎕ Accounting
⎕ Basic Behavioral Health
⎕ Community Health Worker
⎕ Entrepreneurial Studies Level I
⎕ Entrepreneurial Studies Level II
⎕ Hardware and Networking Basics
⎕ Information Technology Entrepreneurship
⎕ Linux Professional
⎕ Management
☐ Adobe Certified Expert: Dreamweaver (9A0-356)
☐ CCNA Routing and Switching (200-120 CCNA OR
100-101 ICND1 AND 200-101 ICND2)
☐ CCNA Security (640-554 IINS)
☐ CCNA Wireless (640-722 IUWNE)
☐ CCNP ROUTE: Implementing Cisco IP Routing (300101 ROUTE)
☐ CCNP SWITCH: Implementing Cisco IP Switched
Networks (300-115 SWITCH)
⎕ Marketing
☐ CCNP TSHOOT: Troubleshooting and Maintaining
Cisco IP Networks (300-135 TSHOOT)
⎕ Mobile App Programming
☐ CompTIA A+ certification (220-801)
⎕ Music Business
☐ CompTIA A+ certification (220-802)
⎕ Network Administration: Cisco Network Professional
☐ CompTIA Linux+ (LX0-103)
⎕ Networking Administration: Cisco
☐ CompTIA Linux+ (LX0-104)
⎕ Pharmacy: Customer Service
☐ CompTIA Network+ (N10-006)
⎕ Programming
☐ CompTIA Security+ (SY0-401)
⎕ Programming and Systems Analysis
☐ Microsoft: Administering Windows Server 2012
(Exam 70-411)
⎕ Real Estate Pre-license
⎕ Small Business Entrepreneurship
⎕ Supervision and Management I
⎕ Web Application Development
⎕ Web & Graphic Design
⎕ Other:
☐ Microsoft: Configuring Advanced Windows Server
2012 (Exam 70-412)
☐ Microsoft: Configuring Windows 8.1 - Microsoft
(Exam 70-687)
☐ Microsoft: Essentials of Developing Windows Store
Apps using C# (Exam 70-484)
☐ Microsoft: Installing and Configuring Windows
Server (Exam 70-410)
Submit Application
☐ Microsoft: Software Development Fundamentals
(Exam 98-361)
Tuition Amount Requested: $
☐ Other (subject to committee approval):
Test Amount Requested: $
Total Requested: $
Committee Use Only
Mail completed applications to:
Rachel Wainhaus
South Mountain Community College
7050 S 24th St, Phoenix, AZ 85042
Application Received/Reviewed by:
Email to Rachel at mycareer@southmountaincc.edu
Award Received by (print name):
Thank you for applying. You will be notified of your application
Signature:
Date:
Amount Awarded: Date Awarded:
Signature: Date:
status within 30 days.
Coordinator Name:
Signature: Date: