Texas Public Education Grant Application

Texas Public Education Grant Application

Completion of this form does not guarantee assistance. Scholarships will be awarded beginning March 2025.
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
Student ID # if returning student
Which semester are you requesting a scholarship for?: *
Student Name*

First NameLast Name
Are you a Texas resident?*

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
What program are you enrolled in or plan to enroll in?
When is your expected graduation from Panola College?:
Email where you can be reached if awarded*

Confirmation Emailexample@example.com
Mobile Number *
Please enter a valid phone number.
Date of Birth *

MonthDayYear
Date
Race/Ethnicity*
Gender*
What is your household income? *
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
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 am registered with the Selective Service*

YesNoI am exempt
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
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*

Clear
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.