Short Term Certificate Grant Application
This application is for students who are applying for the Short Term Certificate program grant. If you do not click Preview & Confirm or Save & Submit Later within 2 hours, your data will be lost.
Attention!
If you do not click Preview & Confirm or Save & Submit Later before the timer expires, your data will be lost.
Applicant Information
First Name
Middle Name
Last Name
Suffix
E-mail
note image Fields with * are required.
 
Short Term Certificate Grant Application
 
 

 
 

 
Name of program for which you are seeking a short-term certificate grant
 

 
Applicant Information
 
Last Name
First Name
 
Date of Birth
Last four digits of Social Security Number
 
Have you applied to Cincinnati State in the past?
Cincinnati State Student ID#
 
Cincinnati State Email Address
 

 
 
 
License/State ID/Passport No.
Issue Date
Expiration Date
 
 

 
Address
 
City
State
Zip
County
 
Contact Phone
E-mail Address
 

 
Are you an International Student?
 
If Yes, are you eligible to work in the United States?
 

 
Gender
Race
Ethnicity
 

 
Are you currently employed?
 
If Yes, Employer Name
Job Title
Employment status
 
If unemployed, how long have you been unemployed?
 
# of individuals in Household
 
Monthly Household Income
 

 
Are you the first person in your family to go to college?
 

 
Military Status
 

 
Have you used training funds in the past and not completed?
 
If Yes, please explain
 

 
 
 
 
 
 
 
Signature
Date