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UA Little Rock CPI Application

Thursday, July 18, 2024
  • 1 Personal Information
  • 2 Children
  • 3 Status/Benefits
  • 4 Education
  • 5 Employment
  • 6 Submit Application

The following information is requested to determine eligibility to participate in the Career Pathways Initiative (CPI). You will be contacted with more information about the program if you appear eligible to participate.

Personal Information

*Skip, if your physical address is the same as your mailing address.

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  • 1 Personal Information
  • 2 Children
  • 3 Status/Benefits
  • 4 Education
  • 5 Employment
  • 6 Submit Application

Children

Do you have any children, 21 years old or younger?

If you answered yes, please complete the following:



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  • 1 Personal Information
  • 2 Children
  • 3 Status/Benefits
  • 4 Education
  • 5 Employment
  • 6 Submit Application

Status/Benefits

Race:
Marital Status:
Gender:
Check all that you currently receive:
Housing status:
How do you pay your bills and support your family?
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  • 1 Personal Information
  • 2 Children
  • 3 Status/Benefits
  • 4 Education
  • 5 Employment
  • 6 Submit Application

Education

Did you graduate?

Did you graduate?

Did you graduate?

Did you graduate?

Are you currently enrolled in classes?
What term do you plan to enroll at UA - Little Rock?
What degree and or certificate do you plan to complete?
Have you applied for Financial Aid (Pell Grant)?
Do you receive student loans?
Are you in default on a student loan?
Do you owe money to another college?
What is your ultimate goal after completing your education at UA - Little Rock?
Have you been in Career Pathways before?
If no, how did you hear about Career Pathways?
What certificate/degree/etc. Will you have already completed upon entry to this program?
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  • 1 Personal Information
  • 2 Children
  • 3 Status/Benefits
  • 4 Education
  • 5 Employment
  • 6 Submit Application

Employment

Current Employment Status:
May we contact your previous employer/supervisor for a reference?

May we contact your previous employer/supervisor for a reference?

May we contact your previous employer/supervisor for a reference?

Professional References


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  • 1 Personal Information
  • 2 Children
  • 3 Status/Benefits
  • 4 Education
  • 5 Employment
  • 6 Submit Application
*Upload Driver's License or Picture ID

Please upload a picture (JPG or PNG images only) of your driver's license or picture ID.

Submit Application

By signing my electronic signature below, I give full permission for the Career Pathways Staff at UA - Pulaski Technical College to verify any information listed in this application, review my financial and academic record including but not limited to my FAFSA application, test scores, transcripts, and participation with the DHS/DWS Programs. I also give permission for CPI to contact the references and previous supervisors that have been provided on this application. This information will be used to determine eligibility to participants in CPI.

By signing my electronic signature below, I understand participation in CPI may be revoked at any time due to falsifying any information or engaging in inappropriate behavior. I also recognize that Career Pathways is not an entitlement program and that services are not guaranteed to applicants and/or participants.

I understand that typing my full name in this box constitutes a legal signature confirming that I acknowledge and agree to the understandings above.

After submitting this form, please e-mail [email protected] or [email protected] the following documents:

  • A copy of your UA LR student schedule
  • A copy of your AR driver's license
  • Copies of your children's birth certificates
  • Most recent 1040 tax form that shows your income
  • Letter from DHS verifying SNAP, ARKids, and Medicaid
  • Copies of Social Security Cards for you and your children

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