GwG Career Certificate Scholarship Form

Full Name:*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone:*

E-mail:*

example@example.com

Moreno Valley Business Name

Only answer if you are the owner or employee of a Moreno Valley Business and DO NOT live in Riverside County.

Gender*

MaleFemaleDecline to stateOther

Date of Birth*

Date

Are you a Moreno Valley Resident?*

YesNo

Are you a Veteran or member of the military community?*

YesNo

Are you currently unemployed?*

YesNo

What is your highest level of education?*

Which Certificate Program would you like to enroll in?*

Career Academy: Data AnalystCareer Academy: Digital MarketerCareer Academy: CybersecurityProfessionalCareer Academy: IT SupportSpecialistCareerAcademy: Project ManagerCareer Academy: UX Designer

Have you participated in Google Career Certificates or used Coursera before?*

YesNo

To qualify for this scholarship, you MUST be a Riverside County Resident (or an employee of a Moreno Valley business) 18 years or older, AND identify with at least one of the following demographics. Please select all that apply:*

Register and watch the required information session below:

Google Career Certificate Scholarship Info Session

Scholarship & Learner Agreement

By signing below, I pledge to maintain and complete the following program requirements:

1. Self-certify that I am a Riverside County Resident, or current employee of a business identified in Moreno Valley living outside Riverside County.

2. Attend or view an information session about the program and expectations.

3. Maintain weekly participation on Coursera to complete my coursework. I undestand that if I do not maintain weekly participation, my scholarship may be revoked.

4. Watch for and respond to communications from the BERC via email and Coursera Notifications

5. I understand the scholarship license ends December 31, 2025 whether coursework is completed or not.

6. Complete my selected Google Career Certificate within six (6) months of scholarship acceptance.

7. I will communicate with the BERC staff to complete a Success Story about my certificate experience and scholarship opportunity.

I understand that my failure to follow these requirements may result in the loss of my Google Career Certificate Scholarship.

Signature*

Google Career Certificate Scholarship Registration Form - 2025

Program Details