Grant and Scholarship Questionnaire

Grant Questionnaire 22-23

This form is to help students qualify for grants and scholarships at Southwest Technical College to be used between July 1, 2022 and June 30, 2023. These grants and scholarships are for charges such as tuition and fees, and cannot be received in cash, but do not need to be paid back. If you have any questions, please call Student Services at 435.586.2899.
Name*

First NameLast Name
Current Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Student ID (If you don't know your student ID, please call Student Services at 435.586.2899 for assistance)
How did you hear about this grant or scholarship?*

A school counselor/advisorSouthwest Tech employee (other than counselor/advisor)The Department of Workforce ServicesMarketing efforts of the Talent Ready BoardSouthwest Tech websiteIn Utah websiteGoogle searchFacebook/InstagramEmailOther
Have you and/or a family member in your household been impacted by COVID-19?*

Currently unemployedDislocated from employmentEmployed at a company that has been impacted by COVID-19None of the above
Briefly describe how COVID-19 has impacted you financially*
Are you interested in completing a college certificate program to improve your employment or self-employment opportunities?*

YesNo
Do you have the time to commit to this certificate program?*

YesNo
What program(s) are you interested in (please limit your selections to 2)*

Information TechnologySoftware DevelopmentPhlebotomyAutomation TechnologyPharmacy TechnicianPractical NursingNursing AssistantMedical Clinical AssistantEmergency Medical TechnicianAdvanced Emergency Medical TechnicianAutomation TechnologyAutomotive TechnicianCulinary ArtsWelding EssentialsProduction WelderProfessional Truck Driving
Did you graduate from a Utah high school?*

YesNo
Are you a Utah resident?*

YesNo
Have you ever been enrolled in college?*

YesNo
Have you ever been enrolled at Southwest Technical College*

YesNo
If you've ever been enrolled in college, please enter the approximate date you were last enrolled

MonthDayYear
Date
Are you a first-generation student (neither one of your parents or legal guardians earned a college degree or certificate)?*

YesNoUnknown
What is your race/ethnicity?*

Caucasian or WhiteBlack or African AmericanAsianNative Hawaiian or Other Pacific IslanderHispanic or LatinoMultipleUnknown
Do you belong to an underserved population (Ethnic or racial minority; individual with a disability; eligible to receive a Pell Grant, Bureau of Indian Affairs, or Department of Workforce Services benefits?*

YesNo
Statement of Understanding

The purpose of these grants and scholarships is to help students gain marketable skills to obtain employment or to improve their employment situation. By submitting this form, you commit that if you are awarded a grant or scholarship, you will take full advantage of that opportunity and that if you change your mind and/or withdraw at any time, you will promptly contact Student Services so that any remaining grant or scholarship money can be used by other deserving students.
Should be Empty:

Grant Questionnaire 22-23

Statement of Understanding