Special Populations Program - CTE Student Support Application

CCTC
The Strengthening Career and Technical Education for the 21st Century Act (Perkins V).

Section One: General Information




















Section Two: Educational Information





Section Three: Employment/Income Information






Indicate approximate income amounts from the sources below, as applicable, per month:

*Note: Do not leave any items blank. Enter "0" for all answers not applicable.
















Section Four: Perkins V Special Populations Categories




Section Five: Career Goals and Requested Services

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The Special Populations Program at Central Carolina Technical College is funded through The Strengthening Career and Technical Education for the 21st Century Act (Perkins V).

All of the information on this form is true and complete to the best of my knowledge. Any information which might be used for statistical purposes may contain my name, but will not be released to the general public. 

I authorize Central Carolina Technical College to consult with and release any pertinent data to support services, prospective employers, and/or training personnel on my behalf.

By clicking the "Submit" button below, I am agreeing to the terms and conditions with in this form