North Alabama Center For Educational Excell-UB-Workforce Development Application

If this question does not apply to you, please respond with N/A.
WORKFORCE DEVELOPMENT-COLLEGE & CAREER PROGRAM APPLICATION
DecaturHuntsvilleScottsboroOther

How many people live in your household, including any children away at school or college?*
YesNo

Documentation of family income is REQUIRED in order to be considered for participation in any NACEE program

2019 Taxable Income: Fill in the 2018 taxable income on the appropriate line. DO NOT use adjusted gross income for this report.*

Rows	Dollar Amount
Line 10 - Form 1040
Certificate of Income Level
Non-tax Filer Form

YesNo
1: 0- $19,1402: $19,141- $25,8603: $25,861- $32,5804: $32,581- $39,3005: $39,301- $46,0206: $46,021- $52,7407: $52,741- $59,4608: $59,461- $66,1809: Above $66,181

If you did not file a tax return or if you receive any untaxed benefits, please list the amount shown on your 2019 "End of Year" statement(s) for all members of your family living in your household.*

Rows	Dollar Amount
Child support received
Welfare benefits (Do not include food assistance)
Social Security benefits that were not taxed
Worker's compensation
Veteran's benefits
Any other untaxed income & benefits

Low income & first generationLow income onlyFirst generation onlyNeither LI or FG
Cohort year*
Status*
Termination date*

MonthDayYear
mm-dd-yyyy
Counselor*

First NameLast Name
Public two-year schoolPublic four-year schoolPublic or non-profit vocational/technical schoolProprietary schoolPrivate, non-profit, two-year schoolPrivate, non-profit, four-year schoolArmed forces
YesNo
Name of school*

All information shared with the North Alabama Center for Educational Excellence is strictly confidential and is used solely for determining client's eligibility for project participation. Additional proof of income or family benefits may be required.

Office location and phone numbers:
Decatur 256.350.6478 / Huntsville 256.372.4600 / Scottsboro 256.259.3072

My signature below indicates, to the best of my knowledge, that the information provided on all forms of this application packet (IDS, IEP, and Contact Sheet) is true, complete, and accurate. I hereby authorize the North Alabama Center for Educational Excellence staff to obtain copies of my or my child's academic and financial assistance records from the educational institution (I) he/she is now attending and from educational institutions (I) he/she will attend in the future.
Client's signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent/Guardian's signature (if dependent student)*

Clear
Date*

MonthDayYear
mm-dd-yyyy