CDL Student - NACTEP Application

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Please complete this form if you have registered for the NHSC CDL 8 Week Training Program.

Email *

Todays Date *

YYYY

Have you taken a NHSC course in the past? If so please explain which course/degree.
*

Are you currently enrolled in the CDL Program?
*

Yes

In order to qualify for NACTEP Funding you must meet one of these criteria. Please select one of the following:
*

I am an individual from a economically disadvantaged family (including Foster Care).

I completed the 2022-23 FAFSA and my EFC# is between 00000 and 05846.

I am an invidual preparing for a non traditional training field of employment.

I am a Native American enrolled in a federally recognized tribe.

I am a single parent (or a single pregnant woman).

I am an individual with a disability.

I am a displaced homemaker.

I am a homeless individual.

I am an individual with other barriers to educational achievement.

None of these apply to me.

What date does your training start.
*

YYYY

First and last names.
*

Student ID#
*

Is your cumulative GPA 2.5 or higher?
*

Yes

What are the last 4 digits of your social security number?
*

What is your campus email?
*

What is your Phone #?
*

What is your mailing address?
*

What is your date of birth?
*

YYYY

What is your gender?
*

Male

Female

Did you earn a High School Diploma or a GED?
*

High School Diploma

GED

I did not earn either

When did you earn you H.S. Diploma or GED?

Are you currently Employed?
*

Full-Time

Part-Time

Seeking Employment Post Training

Not Employed

Not Seeking Employment

If you are employed are you currently working in your field of study (CDL)?
*

Yes

After you complete your training will you go in the field of study in which you are currently seeking training?
*

Go to work

Continue Education

Am not sure

What is your household size?
*

If you are living in a multi family situation please enter the amount of people included in your immediate family. If you have deemed a dependent student you will also need your parents information.

What is your household bi-weekly income, or monthly income divided by 2? Please only include earned from employment. If you are a dependent you can use you parents wage information.
*

What town do you live in?
*

Students commuting from more than 15 miles from the main campus may be eligible for transportation assistance. Verification of address and a completed W-9 will need to be on file if accepted into the program. https://nhsc.edu/students/student-cohorts/nactep/ Please note there are limited spots available for this additional assistance.

Are you currently paying childcare expenses for any dependents?
*

Students who are paying childcare expenses may be eligible for child care assistance through NACTEP. Verification of expense and a completed W-9 will need to be on file if accepted into the program. https://nhsc.edu/students/student-cohorts/nactep/ Please note there are limited spots available for this additional assistance.

Yes

Does not apply to me

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