DOL H1B IT 3 Grant Funding FREE!! TRAINING AND CERTIFICATION EXAMS IT 3 SCHOLARS RECEIVE THE FOLLOWING:

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1 IT 3 Grant Funding FREE!! TRAINING AND CERTIFICATION EXAMS SAP - Human Resources SAP - Materials Management Ethical Hacking & Pen Testing Cloud Computing ITIL Bootcamp Network+ Bootcamp BECOME AN IT 3 SCHOLAR BEFORE IT S TOO LATE!!! IT 3 SCHOLARS RECEIVE THE FOLLOWING: UP TO 2 CLASSES & 2 CERTIFICATION EXAMS PAID FOR BY THE IT 3 GRANT Upcoming courses include: CCNA Bootcamp Security+ Bootcamp Sharepoint Admin CISSP Bootcamp PMP Bootcamp Lean Six Sigma Green Belt+ Fax: IT3-Grant@sjcd.edu Visit our website: These programs are funded by a grant awarded implemented by the U.S. Dept. of Labor s Employment & Training Administration. The information contained in this product was created by the grantee organization and does not necessarily reflect the official position of the U.S. Dept. of Labor. All references to non-governmental companies or organizations, their services, products or resources are offered for information purposes and should not be construed as an endorsement by the Dept. of Labor. The San Jacinto College District is committed to equal employment opportunity for all employees and applicants without regard to race, creed, color, national origin, citizenship status, age, disability, pregnancy, religion, gender, sexual orientation, gender expression or identity, genetic information, marital status, or veteran status in accordance with applicable federal and state laws. No person including students, faculty, staff, part-time, and temporary workers will be excluded from participation in, denied the benefits of, or be subjected to discrimination or harassment under any program or activity sponsored or conducted by the San Jacinto College District on the basis of the categories listed.

2 Information Technology Training for Tomorrow (IT 3 ) Grant Checklist Required Eligibility Documents 1. Complete the application in its entirety (if something doesn t apply indicate N/A) 2. Copy/picture of degree or transcripts (unofficial is fine) 3. Resume 4. Social Security Card Cover Letter (Unemployed/ Underemployed) AND One of the options below: - DL and Birth certificate - Passport DL and Social Security Card - 5. *Veterans and Eligible Spouses must submit one of the following: - DD214 - Orders documenting call to Active status from reserve - Veterans Disability Eligibility Letter *Incumbent Workers must also submit one of the following: - A copy of their most recent paystub - A copy of a W-2 from current employer ***Please note that meeting qualifications or being determined eligible does not guarantee admittance into the programs nor any obligation to provide services and/or training through the IT 3 Grant. Veteran s preference is applicable to participants. Individuals interested in applying are required to submit legible copies (via scan or fax transmission) to Grant staff at (IT3-Grant@sjcd.edu). Please contact grant staff via prior to submission in order to be issued a password for your documents. If you would like to remit documents in person, please us for an appointment between ( ) and bring them to the Continuing and Professional Development Office (Building1, room 207) on San Jacinto College Central Campus (8060 Spencer Hwy, Pasadena, TX 77505).

3 IDENTIFYING INFORMATION: Name Street Address City, State, Zip Date of Birth Social Security Number CONTACT INFORMATION: Phone Number Alternate Phone Number Address DEMOGRAPHIC INFORMATION: GENDER (Please check one.) DOL H1B Information Technology Training for Tomorrow (IT 3 ) Project A U.S. Department of Labor/Employment and Training Administration Grant Male Female ETHNICITY (Please check one.) Hispanic or Latino RACE (Please check one.) Native American/Alaskan Asian Black Pacific Islander White More than One Race U.S. CITIZENSHIP (Applicants must be U.S. Citizens in order to receive training funded by the IT 3 Grant.) Are you a U.S. Citizen? ELIGIBLE VETERAN STATUS (Must submit DD214) Are you a veteran or an eligible spouse of a veteran? Do you agree to include this application and its information with the Paid Veteran Internship Program (Veterans Fast Track to Employment? DISABILITY (Physical or Mental Impairment disclosure is used for federal reporting purposes and will not impact your participation.) Do you have any disabilities? PLEASE REVIEW THE TRAINING OPPORTUNITIES BY VISITING THEN LIST YOUR TOP 3 CLASS CHOICES IN ORDER OF PREFERENCE: EDUCATION LEVEL: EMPLOYMENT STATUS: GED/High School Diploma Some College Associate s Degree Bachelor s Degree Post Baccalaureate Employed Underemployed* Unemployed Long-term unemployed (27 weeks) *Note: A person is considered underemployed if they are working part time, but seeking full time employment OR if they have not yet connected with a job that provides pay and responsibility reflective of their experience and education level. IF INCUMBENT Worker, COMPLETE THE FOLLOWING QUESTIONS: Current Job Title Employer Wage/Salary & Rate Is this employment in information technology-related occupations? IF YES, do you expect to receive a raise in wage due to this training? Yes No_ WORK EXPERIENCE-Information Technology Sector: How many years of work experience do you have? 0-1 Years 1-2 Years 2+ Years EMPLOYMENT OUTLOOK (In order to be considered for grant funding, you must make contact with at least one potential employer.) COMPANY POINT OF CONTACT: Name Phone Number Is this company currently looking for an employee with the certifications you are seeking? INCOMPLETE APPLICATIONS WILL BE CONSIDERED NONRESPONSIVE TO GRANT REQUIREMENTS AND NOT AWARDED GRANT FUNDING. This confidential information is being requested to comply with federal reporting requirements of the U.S. Department of Labor.

4 Information Technology Training for Tomorrow (IT 3 ) Project A U.S. Department of Labor/Employment and Training Administration Grant To be considered for the IT 3 Grant a participant must meet the following conditions at the time of enrollment (Please initial next to those that apply): Is an incumbent worker currently employed at a company that is participating in the IT3 Grant and agree to have my information shared with my employer is without a job for 27 weeks or more and wants and is available to work and is able to provide documentation of Unemployment Insurance (UI) eligibility; OR Lost their job during the recent recession (commencing January 1, 2008 forward), and have exhausted unemployment benefits; OR Has not yet reconnected with a job that provides comparable responsibility and pay (underemployment); OR Is working a part-time job(s) when they want a full-time job, or who have become discouraged and have stopped looking for a job. I, _, attest that the information I have provided on these forms PLEASE PRINT NAME CLEARLY is accurate, current, and honest. I further confirm that I understand and agree to all expectations of truthfulness and candidness related to the information I have provided herein, and recognize that my failure to fully disclose accurate, current, and honest information could result in my exclusion from participation or even criminal and civil penalties. Lastly, I understand that my information may be shared between the college, with my employer, with the Department of Labor and other related parties to track the program s progress. I consent to this sharing of my information only as it relates to the project. SIGNATURE _ (NO Digital Signatures) DATE

5 Participant Expectations I. Please complete the IT3 application Packet a. Supporting documentation i. College transcripts (Unofficial are fine) or copy/picture of your degree/certification ii. Birth certificate or passport or Driver s License AND SSN Card 1. This is an eligibility requirement and we secure all data on the college s secure network. 2. If we don t have the supporting documents, your application can t be reviewed for approval b. Remit application with supporting documents either via scan and or fax c. Submissions made in person require an appointment to ensure that grant staff is onsite to take documents (Only submit documents to grant staff) d. It is the student s responsibility to ensure receipt of an which documents grant approval and then a written confirmation that you are, indeed, included on the roster. Recommend Weekly follow-up II. Course Selection a. You will be advised via when your particular training request is upcoming b. You will be asked to respond if you are able to attend i. If you commit to the class and must cancel, notification must be made via at least but NLT 1 week before the class start date. ii. If you commit and no-show without the appropriate notice, you will not be eligible to participate in additional grant activities iii. If you have an emergency situation that can be documented, we will review it on a case-by- case basis iv. Attendance is expected to all classes and excessive absences (or lost hours) will result in a nonmastery (non-passing) grade which will make the participant ineligible to sit for the certification exam. 1. This includes Virtual Courses because, as for the grant purposes, attendance in the classroom is still mandatory. v. DO NOT leave materials/books in the classroom c. You will receive an notification to prepare for your class about one week prior to the class start III. Certification Exam a. In order to sit for the certification exam you must successfully complete the course. b. In order to take your next course, you must successfully pass the certification exam to the first course. c. Vouchers i. After you have applied to take the exam you wish to pursue AND you have completed the course successfully you will forward the approval to sit for the exam from the certifying body to the grant staff and we will then request payment for the exam ii. In the event that there isn t an application to the exam, please the grant staff at the course end date so that we can coordinate issuance of your voucher so that you can schedule the exam. IV. If you are working with your company for training, please ensure that you coordinate with your company s POC first to avoid confusion. Printed Name Signature