[go: up one dir, main page]
Scribd
Upload
73 views1 page

Self Certification Form

This document is an application for financial aid that requires self-certification of eligibility criteria. The applicant certifies that the information provided about child care, transportation, scholarships, and other expenses is true and accurate, and understands misrepresentation could result in termination of services or penalties. A parent or guardian must also sign, and a Workforce Solutions staff member verifies the information was provided by the applicant and signatures.

Uploaded by

Timothy Henton
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
73 views1 page

Self Certification Form

This document is an application for financial aid that requires self-certification of eligibility criteria. The applicant certifies that the information provided about child care, transportation, scholarships, and other expenses is true and accurate, and understands misrepresentation could result in termination of services or penalties. A parent or guardian must also sign, and a Workforce Solutions staff member verifies the information was provided by the applicant and signatures.

Uploaded by

Timothy Henton
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Child Care Scholarship Transportation Other

Application for Financial Aid


Self-Certification
I hereby certify under penalty of perjury, that the following information is true:

I attest that the information stated above is true and accurate, and understand that the above
information, if misrepresented or incomplete, may be grounds for immediate termination of
Workforce Solutions services and/or penalties as specified by law.

Signature: Date: / /

Signature of Parent or Legal Guardian:

Address:

Phone Number:

The above self-certification documents the following eligibility criteria:

certification
I certify that the information recorded on this form was provided by the individuals whose signatures appear above.

Workforce Solutions Career Office Staff Signature:

Printed Name: Date: / /

Workforce Solutions is an equal opportunity employer/ program. Auxiliary aids and services are available upon request
to individuals with disabilities. Texas Relay Numbers: 1-800-735-2989 (TDD) 1-800-735-2988 (voice) or 711 234-FA4-E
08-03-11

You might also like