Hill College - Counseling - Carl Perkins Grant
Hill College
2019-20 Perkins Reimbursement Application

Hill College gives equal consideration to all applicants for admission, employment, and participation in its programs and activities without regard to race, creed, color, national origin, gender, age, marital status, disability, or veteran status. The child care, transportation assistance and textbook assistance programs are made possible through, and dependent upon continued funding of the Carl D. Perkins Vocational Act and the Texas Higher Education Coordinating Board.
Please Check the Service that is Needed
Transportation       Childcare       Books/Supplies

Hill County Campus     Johnson County Campus     Burleson Center     Web

Semester Attending
Fall       Spring       Summer I       Summer II
Full Name Date
Address Student ID
City Birth Date (MMDDYYYY)
Zip Phone Number (no dashes)
Enrollment Status
Full Time Part Time Course of Study
(Major must be technical)
GPA (#.##)
Check all that apply to you:
Individual with disablitites
Individual from economically disadvantaged family, including low-income youth and adults
Individual preparing for non-traditional fields
(An individual entering a technical program that is non-traditional for their gender.)
Single parent, including single pregnant women
Out-of-workforce individual
English learner
Homeless individual described in section 725 of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11434a)
Youth who are in, or have aged out of, the foster care system
Youth with a parent who is a member of the armed forces and is on active duty
Please answer the following questions:
Yearly Household Income (Including Child Support)
Number of children dependents
Have you completed your FAFSA? Yes No
Are you a United States citizen? Yes No
If you are not a U.S. Citizen, have you been granted Permanent Resident Status? Yes No
Are You: Household Size
(Definition of adult: person who is applying for assistance)
Married One adult, zero children
Single One adult, One Child
Legally Separated One adult, two or more children
Divorced Two adults, Zero children
Widowed Two adults, One child
Never Married Two adults, Two children
    Two adults, Three children  
    Two adults, Four or more children  
Are you currently receiving services or funding from: (Check ALL that apply)
Assistance Amount per month
Pell Grant
Texas Workforce Comission
Department of Asssistive and Reabilitative Services
Veterans Administration Benefits
Texas Department of Human Services
Social Security
Child Support
WIC/Lone Star Card
Funding for child care or transportation

Student Certification and Release of Information

I, , certify all the information on this application is complete and accurate. I will be a student in a career/technical program. I will provide all documentation necessary, including but not limited to: proof of income, copy of birth certificate(s), a copy of child(ren)'s social security card(s), or any other item(s) necessary to verify needed information. I understand that any discrepancies or inaccuracies may result in the cancellation of any services provided and/or the requirement of repayment of any funds received. I hereby give the Academic Advising & Success Center staff my permission to share any information concerning my education funding and/or transition into the employment field with faculty, professional staff members and/or sponsoring agency members. This permission is granted in order for me to be assisted as my eligibility will allow. I understand all other financial aid allows each student to receive their maximum allotment for his/her circumstances. I am aware all services received are contingent upon the the AVAILABILITY OF FUNDS, AND my continued completion of the required components of the Academic Advising & Success Center, and I have made sufficient progress toward my major with a 2.0 GPA or better. I understand that the information supplied is for the current grant year beginning September 1, and ending August 31, of each year.