• GAP TUITION/PACE ASSISTANCE

    APPLICATION

  • BASIC INFORMATION

  • Format: (000) 000-0000.
  • Preferred Method of Contact*
  • Best Time of Day to Contact*
  • Sex*
  • Ethnicity
  • Are you a U.S. Citizen?*
  • Are you legally eligible to work in the United States?*
  • Are you a resident of Iowa?*
  • Are you a veteran, current or former member of the U.S. Armed Forces?*
  • Are you the spouse or child of a veteran?*

  • ELIGIBILITY

  • What is your marital status?*
  • Do you have any children or dependents that you claim on your income tax return?*
  • Do you receive assistance from the state (such as Food Assistance, Title 19, etc)?*
  • Has your income significantly changed since filing your recent federal income tax return?*

  • You will need to provide a copy of your Federal or State Income Tax Return you filed or were claimed on.

  • Have you received GAP funding previously?*

  • EDUCATION

  • What is your highest level of education completed?*

  • EMPLOYMENT

  • What is your current employment status?*
  • What types of employment challenges have you experienced within the last year? (Please select all that apply.)*
  • Do you have a current up-to-date resume?*
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  • Please rate your interviewing skills (5 - Outstanding and 1 -Poor)*
  • Are you proficient with computer skills?*
  • If yes, please list your skills.
  • Have you ever been arrested, charged or convicted of a misdemeanor, felony or other pending charge?*
  • Since you answered yes to the question regarding arrests and convictions, please select all that apply:*
  • Have you ever needed or do you currently need substance abuse assistance?*

  • WORK HISTORY

    (Work history can include volunteer work, part-time employment and self-employment.)

  • PROGRAM RESEARCH

  • What GAP Program(s) are you interested in?*
  • Do you have your CDL Permit?

  • Signature - Applications are valid for 6 months from date of signature

    I certify that the information I have provided on this application is true to the best of my knowledge. I am also aware that the informatio I have provided may be reviewed and verified, and that I may have to provide documents to support this information. I allow release of this information for documentation puruposes.

    Further, I understand that this information will be used to determine my eligiibility for the Gap Tuition Assistance program. I am aware that I am subject to immediate termination and that I may be prosecuted for fraud and/or perjury if I am found ineligible after enrollment.

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