Continuing Education ARPA Grant Registration Form

Through funding provided by the American Rescue Act Plan, Coronavirus State and Local Fiscal Recovery Fund, Lee County residents may be eligible for tuition and fee scholarships. Tuition and fee scholarships are dependent on individual assistance eligibility.

First Name

Last Name

Street Address

City

State

Zip Code

Phone Number

Date of Birth

Email Address

Please select the statement that best applies to you.

I am an individual who wants to work and is available for work and I am unemployed, or have looked for work sometime in the past 12 months.

I am employed part-time but want and am available for full-time work.

I am employed but seeking a position with greater opportunities for economic advancement.

What is your current household size (including yourself)?

How many kids are in your household?

What is your household yearly income?

Gender

Where did you learn of this course?

Highest Level of Education

Course

If the course you chose is Accounting Technology, Real Estate Paralegal, Network Security, Computer Programmer, Small Business Management, or Emergency Medical Technician please provide your BUC ID #. If you did not choose one of those, put N/A.

Do you qualify as a Florida resident?

Yes

Application Certification Statement

IMPORTANT: APPLICANT MUST READ THE FOLLOWING STATEMENT AND CHECK THE BOX BELOW

By checking the box, I certify that: I understand that this application is for residents of Lee County who wish to receive tuition and fee support to complete a Micro-credential and Digital Badge through Florida SouthWestern State College. I certify that all the information given in this application is complete, accurate, and true. I authorize the release of information concerning my academic progress and demographic data to Lee County. I understand that I must participate in a survey following my participation in the FSW Micro-credential program in order to receive funding. I understand that if I do not complete the program for which I received tuition and fee support, I may be required to reimburse FSW for the tuition and fees associated with the program.

Requests for refund five days prior to the first class meeting will be granted. Due to the short-term nature of most Continuing Education programs, refunds will not be granted on or after the first class meeting. By submission of this form you are stating that you accept our refund policy.