Continuing Education (non-credit) Funding Intake Form

Worker Retraining funding is no longer available for Non- credit CE courses/training programs. Funding for these courses may be available thru the WIOA (Workforce Innovation and Opportunity Act). For more information please contact Fikru Diro at: fdiro@shoreline.edu.

Applicant First and Last Name

Applicants phone number

Applicant's Email Address

Applicant's Billing Address (Please include the full address, city, state, zip code)

Applicant birthdate

ctcLink Number (if known)

Program name

Program ID number

Link to program website

Cost of program

Number of course hours

Full time or part time status (if known)

Start date

End date

Are you a Veteran?

Are you currently receiving unemployment, training benefit and/or Commissioners Approved training?

Where did you hear about this program?

Are you paying for yourself or using a funding source?

Paying myself

Outside funding

Are you enrolled in ESL or ABE?

ESL

ABE

Have you been conditionally approved for funding by a 3rd party funding source? If yes, select which

WOIA

DVR

UI

Other

Other funding source if not listed above

Name of funding source counselor/program manager

Phone number of funding source counselor/program manager

Email of funding source counselor/program manager

Address of funding source counselor/program manager

Name of ed2go contact if known

Email of ed2go contact if known

Additional comments or information not listed?

Your name

Your email address

Verification Code

Continuing Education (non-credit) Funding Intake Form

Other Fields