Texas Public Education Grant Application

Texas Public Education Grant Application

Completion of this form does not guarantee assistance.
Have you filled out the registration form for a Workforce/Continuing Education program (For ex: Dental Assisting, Phlebotomy, Truck Driving, Nurse Aide, Patient Care Technician)?*

YesNo
Which semester are you requesting a scholarship for?: *
Student Name*

First NameLast Name
Student ID # if returning student
Date of Birth *

MonthDayYear
Date
Gender*
Mobile Number *
Please enter a valid phone number.Format: (000) 000-0000.
Email where you can be reached if awarded*

Confirmation Emailexample@example.com
Race/Ethnicity*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If I choose not to attend the semester I have registered for, it is my responsibility to withdraw from all of my courses before classes start even if I have financial aid in place or hae a payment on my account*

I understand
Are you a Texas resident?*

YesNo
Do you have an associate or bachelor degree?*

YesNo
Are you currently enrolled at Panola College?*

YesNo, but I plan to enroll soonNo, I am only able to enroll with financial assistance
Will you be enrolled in high school during the semester in which you are requesting a scholarship?*

YesNo
Are you receiving a Texas Grant at any other institution this academic year?*

YesNo
What program are you enrolled in or plan to enroll in?
When is your expected graduation from Panola College?:
I am registered with the Selective Service*

YesNoI am exempt
Have you ever been convicted of a felony or an offense under Chapter 481, Health and Safety Code (Texas Controlled Substances Act), or under the law of another jurisdiction involving a controlled substance as defined by Chapter 48, Health and Safety Code?*

YesNo
What is your household income? *
Are you a child support obligator who is more than 30 days delinquent in paying child support?*

YesNo
I am economically disadvantages or a low-income family (receiving assistance through SNAP, Social Security, and/or State or local income-based, public assistance)*

YesNoUnsure
I herby certify that the information I have provided in this statement is true and correct. I understand that if I fail to provide accurate information, I may be required to reimburse the institution and penalties may be imposed. I also understand that it is my responsibility to inform the financial aid office if my status concerning the statement of eligibility changes at any time while attending the institution.*

YesNo
If you have not done so already, you MUST complete the 2025-26 FAFSA at the following link: https://studentaid.gov/h/apply-for-aid/fafsa
Signature*
You must fill out your registration BEFORE applying for this grant.

CDL Truck Driving: https://www.jotform.com/PanolaMain/cdl-wce-registration-form

Certified Nurses Aide CNA: https://form.jotform.com/PanolaMain/wce-cna-registration-form

Dental Assisting: https://form.jotform.com/PanolaMain/dental-assisting-wce-registration-f

EKG Technician: https://form.jotform.com/PanolaMain/ekg-wce-registration-form

Patient Care Technician PCT: https://form.jotform.com/PanolaMain/wce-patient-care-technician-registr

Pharmacy Technician: https://form.jotform.com/PanolaMain/pharmacy-technician-wce-registratio

Phlebotomy: https://form.jotform.com/PanolaMain/phlebotomy-wce-registration-form
Should be Empty:

Texas Public Education Grant Application

You must fill out your registration BEFORE applying for this grant.