CETA Application for Assistance

Application for Assistance with Continuing Education/Tuition

This application is for single-parents who need help paying tuition and fees for continuing education after high-school, work-force retraining, or fees related to obtaining employment.
Contact Information

Parent/head-of-household contact information
Full Name

First NameLast Name
E-mail
Home Phone#

Area CodePhone Number
Cell Phone#

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Birthdate:

MonthDayYear
Current Employer?
Technical/Vocational SchoolCollege/University TuitionCertification ProgramDefaulted School LoansCriminal Record Expungement
Household Members
Tell us the names, relationships, and ages of those who live with you:

Contact Information