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PO Box 1464 Dillingham, AK 99576 Phone: (907) 842-4370 or (800) 478-4370
Fax: (907) 842-4336 or (888) 325-4336 Website: www.bbedc.com 1 | P a g e
2017 BBEDC Vocational/Technical Training Program
ELIGIBILITY REQUIREMENTS: (please check off)
BBEDC accepts Voc-Tech applications from CDQ residents who are seeking financial assistance for vocational training. BBEDC
will prioritize training at Southwest Alaska Vocational Education Center (SAVEC), secondly in-state and as a last resort, out-of-state.
Applicants must demonstrate in writing why training outside the region is necessary.
In order to qualify for BBEDC Voc/Tech Program Funding, the training must meet at least one of the following criteria:
Fisheries related training directly related to the fisher’s operation including industry related skills training or training that could lead to entry into
a Bristol Bay commercial fishery as a crewman.
Full-time vocational technical education program leading to a nationally recognized certification, license or degree that could lead to direct
employment in the vocation.
Job-readiness training that would provide new or enhance current employment skills for those unemployed with the goal of increasing
employability.
Employer mandated training that would result in continued employment, a direct employment advancement or pay increase with said employer
(limited to $2,500 per year).
Continuing education training to maintain certifications that are required for current occupation.
Students who are pursuing degrees/certifications/licenses or training directly related to their primary employment through online
delivery, it is a requirement of the Vocational Training Program to use training providers in the order of priority outlined above.
Written justification for use of a particular training provider must be provided for all training outside of the region. An eligibility
determination of these applications will be considered by BBEDC program staff on a case-by-case basis.
The requirements of eligibility are:
Complete BBEDC Voc/Tech Funding Application
Provide completed budget sheet
BBEDC Residency form (located on homepage under Quick Links (www.bbedc.com) and a copy of one of the following:
□ 2016 Alaska Permanent Fund Dividend records (https://pfd.alaska.gov)
□ Current rent receipt, electric/fuel bill or other proof of maintaining a home in a BBEDC CDQ community
□ Most recent employment or unemployment records (ex. W-2, check stub, statement)
□ Recent TANF, Food Stamp benefit award letter, or BBNA Heating Assistance approval letter
□ Current ADF&G commercial/sport fishing or hunting license (limited entry permit card will not be accepted)
Acceptance letter or proof of registration from the school you are applying
Provide two letters of recommendation
1. Professional (school or work related)
2. Personal
Submit an essay or letter of request that includes:
(1) Your training and employment goals
(2) How your training relates to your goals
(3) Employment opportunities after completion of your training
Release of Information Form
Relationship Disclosure Form (located on homepage under Quick Links (www.bbedc.com)
Justification letter if training is outside of the region
APPLICATIONS MUST BE SIGNED AND COMPLETE NO LESS THAN SEVEN BUSINESS DAYS PRIOR
TO THE STARTING DATE OF THE CLASS.
LATE APPLICATIONS WILL BE DENIED FUNDING.
Note: Applicants in default in any BBEDC programs are no longer eligible to participate in additional BBEDC
programs or services until fully compliant.
PO Box 1464 Dillingham, AK 99576 Phone: (907) 842-4370 or (800) 478-4370
Fax: (907) 842-4336 or (888) 325-4336 Website: www.bbedc.com 2 | P a g e
2017 BBEDC VOCATIONAL/TECHNICAL PROGRAM FUNDING APPLICATION
Please Print
Full Name as it Appears on ID/AKDL: Date:
Address:
City: State: Zip:
Home Phone: ___________________________Business/Message Phone: ____________________________
Social Security Number_____________________ Email Address: __________________________________
Date of Birth __________ Alaska Airline Mileage # ____________
Employment & Training Goals:
1. What specific job do you have in mind after completion of this training program?
____________________________________________________________________________________
2. What training are you interested in? ______________________________________________________
3. What specific training program are you enrolled in? __________________________________________
School Name: ____________________________ Contact Name/Phone: _______________________
School Address: ______________________________________________________________________
Note: If training facility is located out of region or is through online delivery, please justify the use of
this facility in a separate letter and include school contact information.
4. Training Start Date/Time:______________________ Completion Date/Time:
5. What certification, license or degree will you have upon completion of this training program?
6. Is this training related to your primary employment? ___Yes ___No
If yes, how is it related?________________________________________________________________________
7. Is this training mandated by your employer? ___Yes ___No
8. Have you previously received Employment/Training services from BBEDC? ____Yes ____ No
What Year: ______
9. What employment opportunities and with which company are there for you upon completion of this
training? ___________________________________________________________________________
10. Do you plan to return to utilize your training in the Bristol Bay Region upon completion?
____Yes____ No
PO Box 1464 Dillingham, AK 99576 Phone: (907) 842-4370 or (800) 478-4370
Fax: (907) 842-4336 or (888) 325-4336 Website: www.bbedc.com 3 | P a g e
Education History
Employment History
Name: Location: (city/state) Major course or Subject: Dates Attended:
Graduated
Date:
High School:
From: To:
Technical/Trade:
From: To:
College: (list all attended)
Other Training/Education:
a. If you previously began, but did not complete a vocational / technical training program please explain WHY? (Be Specific)
Last or Present Employer Nature of Business Job Title:
Address: Phone Number Brief Description of Job Duties:
City State Zip Code
Supervisor’s Name Phone Number
Base Salary: Dates Worked:
From ____________To____________
Reason for Leaving:
Employer Nature of Business Job Title:
Address: Phone Number Brief Description of Job Duties:
City State Zip Code
Supervisor’s Name Phone Number
Base Salary: Dates Worked:
From ____________To____________
Reason for Leaving:
Employer Nature of Business Job Title:
Address: Phone Number Brief Description of Job Duties:
City State Zip Code
Supervisor’s Name Phone Number
Base Salary: Dates Worked:
From ____________To____________
Reason for Leaving:
PO Box 1464 Dillingham, AK 99576 Phone: (907) 842-4370 or (800) 478-4370
Fax: (907) 842-4336 or (888) 325-4336 Website: www.bbedc.com 4 | P a g e
Budget Information:
Please include your training budget for the program you have applied for. Include only the budget information
that is appropriate. This section must be complete. BBEDC will not make an award if the total training
costs are not met.
Actual Costs: Student's Contribution
Description Amount Description Amount
Tuition $ Savings / Employment $
Books/Fees $ BBNA $
Airfare $ BBNC $
Room $ Permanent Fund Dividend $
Board $ State (WIA) $
Miscellaneous $ Student Loan $
(Rental Cars Are Not Covered) Other sources____________ $
TOTAL $ TOTAL $
Why did you apply for this program and how will it assist you?
AMOUNT REQUESTED FROM BBEDC $
Applicant’s Signature Date
By signing this application I warrant that all information submitted is true and accurate to the best of my
knowledge. Any falsification or misrepresentation of the information submitted will result in the
termination of benefits and the applicant may be required to pay back any funds that were provided by
BBEDC as a result of the information provided.
NOTE: All information submitted in and with this application is confidential and will
only be used as a tool for consideration of applicant’s request for funding by BBEDC.
PO Box 1464 Dillingham, AK 99576 Phone: (907) 842-4370 or (800) 478-4370
Fax: (907) 842-4336 or (888) 325-4336 Website: www.bbedc.com 5 | P a g e
Authorization for Release of Information
I hereby authorize the release of any and all information needed by the Bristol Bay Economic
Development Corporation contained in city councils, villages, state, federal, private or educational
Agencies’ records to the organization listed below:
BRISTOL BAY ECONOMIC DEVELOPMENT CORPORATION
EDUCATION, EMPLOYMENT & TRAINING PROGRAMS
POBOX 1464
DILLINGHAM, ALASKA 99576
This information is to be used for the verification of the eligibility of ____________________________________
This authority shall continue in effect until this student is no longer enrolled in BBEDC’s Education, Employment
and Training Program.
Signature: __________________________________________Date:_____________________________________
Social Security Number: _____________________________Date of Birth: _______________________________
In addition:
I hereby authorize BBEDC and the awarding organization to publicize my name, institution, type of training, how
long it was, and village of residency to further encourage people of the Bristol Bay region to seek higher
educational and training opportunities. I authorize the same organization to provide my name for employment
purposes. This authority shall continue in effect until I am no longer in the Education, Employment & Training
Program.
Signature:__________________________________________Date:_____________________________________
I authorize you to furnish the Bristol Bay Economic Development Corporation with any and all information that
you have concerning my work/employment records and me. Information of a confidential or privileged nature may
be included. Your reply will be used to assist in determining my qualifications for the position and/or training I am
seeking. I further understand that the information you furnish will not be disclosed to any person not connected the
Bristol Bay Economic Development Corporation hiring practices, including myself.
I understand my rights under Title 5, United States Code, Section 552a, and the Privacy Act of 1974. I hereby
waive those rights with the understanding that the information furnished will be used by the Bristol Bay Economic
Development Corporation and retained by them in confidence.
I hereby release you, and your organization from any liability of damages that may result from furnishing
the information requested.
Applicant’s Printed Name:
Applicant’s Signature: __________________________________________Date:
NAME: UA ID (or SSN): (Last) (First) (M I)
SEMESTER OF ENROLLMENT: Year 20 _ _ Fall Spring Summer Date of Birth (MM/DD/YYYY):
CURRENT MAILING ADDRESS: Day Phone:
Evening Phone:
Email Address:(City) (State) (Zip)
Residency1: Students seeking Alaskan residency or a waiver of non-resident surcharge must complete an Application for Resident Tuition and provide required documentation to the Office of Admissions before the published first day of instruction (UA Board of Regents RegulationR05.10.05). See reverse side for information.
DEMOGRAPHIC INFORMATION: See reverse side for information and codes.
Sex: Male Female Prefer not to answer Ethnicity: Hispanic or Latino Not Hispanic or Latino Race2: Vet/Military Status3:
US Citizen? Yes No If no, Nation of birth: Nation of citizenship:
Visa Type: Permanent Resident? Yes NoFor instructions on withholding directory information, please see INFORMATION RELEASE on reverse side4.
PRIOR EDUCATION INFORMATION:Name of high school you are attending: Location (city/state):
Expected graduation date? (MM/DD/YYYY):
COURSE INFORMATION (Complete all information requested below. Refer to the Class Schedule for course information)CRN Dept. Course
NumberSection Course Title # of
Credits“Yes” if
Audit
I understand I, or my parent, are responsible for all applicable UAF academic regulations, tuition and fees whether or not I successfully complete the course or courses in which I am enrolling5. The university will not initiate a drop for non-payment5.
Student’s Signature: Date:Parent’s Signature: Date:
OFFICE OF ADMISSIONS AND THE REGISTRAR ONLY:Processed By: Date:
HIGH SCHOOL ENROLLMENT FORMRECEIVED
Office use onlyPTo enroll at UAF while still a high school student, you must
• Complete this form.• Meet prerequisites of the course or courses in which
you want to enroll.• Submit the completed form to the Office of
Admissions and the Registrar during the regularregistration period.
• Pay tuition and fees by the last day of fee payment inthe semester you are enrolled.
• If you want to use university credit to meet high schoolrequirements, contact your high school counselorbefore you enroll at UAF.
• Students may choose not to release their directoryinformation by completing a “request to withhold orrelease directory information” form, available at theOffice of Admissions and the Registrar.*
Office of Admissions and the Registrar 907-474-7500 • [email protected] • [email protected]
NAME: UA ID (or SSN): (Last) (First) (M I)
SEMESTER OF ENROLLMENT: Year 20 _ _ Fall Spring Summer Date of Birth (MM/DD/YYYY):
CURRENT MAILING ADDRESS: Day Phone:
Evening Phone:
Email Address:(City) (State) (Zip)
Residency1: Students seeking Alaskan residency or a waiver of non-resident surcharge must complete an Application for Resident Tuition and provide required documentation to the Office of Admissions before the published first day of instruction (UA Board of Regents RegulationR05.10.05). See reverse side for information.
DEMOGRAPHIC INFORMATION: See reverse side for information and codes.
Sex: Male Female Prefer not to answer Ethnicity: Hispanic or Latino Not Hispanic or Latino Race2: Vet/Military Status3:
US Citizen? Yes No If no, Nation of birth: Nation of citizenship:
Visa Type: Permanent Resident? Yes NoFor instructions on withholding directory information, please see INFORMATION RELEASE on reverse side4.
PRIOR EDUCATION INFORMATION:Name of high school you are attending: Location (city/state):
Expected graduation date? (MM/DD/YYYY):
COURSE INFORMATION (Complete all information requested below. Refer to the Class Schedule for course information)CRN Dept. Course
NumberSection Course Title # of
Credits“Yes” if
Audit
I understand I, or my parent, are responsible for all applicable UAF academic regulations, tuition and fees whether or not I successfully complete the course or courses in which I am enrolling5. The university will not initiate a drop for non-payment5.
Student’s Signature: Date:Parent’s Signature: Date:
OFFICE OF ADMISSIONS AND THE REGISTRAR ONLY:Processed By: Date:
HIGH SCHOOL ENROLLMENT FORMRECEIVED
Office use onlyPTo enroll at UAF while still a high school student, you must
• Complete this form.• Meet prerequisites of the course or courses in which
you want to enroll.• Submit the completed form to the Office of
Admissions and the Registrar during the regularregistration period.
• Pay tuition and fees by the last day of fee payment inthe semester you are enrolled.
• If you want to use university credit to meet high schoolrequirements, contact your high school counselorbefore you enroll at UAF.
• Students may choose not to release their directoryinformation by completing a “request to withhold orrelease directory information” form, available at theOffice of Admissions and the Registrar.*
Office of Admissions and the Registrar 907-474-7500 • [email protected] • [email protected]
NAME: UA ID (or SSN): (Last) (First) (M I)
SEMESTER OF ENROLLMENT: Year 20 _ _ Fall Spring Summer Date of Birth (MM/DD/YYYY):
CURRENT MAILING ADDRESS: Day Phone:
Evening Phone:
Email Address:(City) (State) (Zip)
Residency1: Students seeking Alaskan residency or a waiver of non-resident surcharge must complete an Application for Resident Tuition and provide required documentation to the Office of Admissions before the published first day of instruction (UA Board of Regents RegulationR05.10.05). See reverse side for information.
DEMOGRAPHIC INFORMATION: See reverse side for information and codes.
Sex: Male Female Prefer not to answer Ethnicity: Hispanic or Latino Not Hispanic or Latino Race2: Vet/Military Status3:
US Citizen? Yes No If no, Nation of birth: Nation of citizenship:
Visa Type: Permanent Resident? Yes NoFor instructions on withholding directory information, please see INFORMATION RELEASE on reverse side4.
PRIOR EDUCATION INFORMATION:Name of high school you are attending: Location (city/state):
Expected graduation date? (MM/DD/YYYY):
COURSE INFORMATION (Complete all information requested below. Refer to the Class Schedule for course information)CRN Dept. Course
NumberSection Course Title # of
Credits“Yes” if
Audit
I understand I, or my parent, are responsible for all applicable UAF academic regulations, tuition and fees whether or not I successfully complete the course or courses in which I am enrolling5. The university will not initiate a drop for non-payment5.
Student’s Signature: Date:Parent’s Signature: Date:
OFFICE OF ADMISSIONS AND THE REGISTRAR ONLY:Processed By: Date:
HIGH SCHOOL ENROLLMENT FORMRECEIVED
Office use onlyPTo enroll at UAF while still a high school student, you must
• Complete this form.• Meet prerequisites of the course or courses in which
you want to enroll.• Submit the completed form to the Office of
Admissions and the Registrar during the regular registration period.
• Pay tuition and fees by the last day of fee payment in the semester you are enrolled.
• If you want to use university credit to meet high school requirements, contact your high school counselor before you enroll at UAF.
• Students may choose not to release their directory information by completing a “request to withhold or release directory information” form, available at the Office of Admissions and the Registrar.*
Office of Admissions and the Registrar 907-474-7500 • [email protected] • [email protected]
1 RESIDENT AND NON-RESIDENT TUITIONFirst-time non-degree students or students returning toenrollment after more than a two-year absence are considerednon-residents until they submit an Applicationfor Resident Tuition with this registration form beforethe first published day of instruction and are approved(for the purposes of residency pursuant to UA Board ofRegents Regulation R05.10.05) as a resident of Alaska.For more specific criteria, please refer to the UAApplication for Resident Tuition Assessment atwww.alaska.edu/files/studentservices/student/residency-form/Residency-Application-enterable.pdf.
2 RACE*Code DescriptionAA Alaska Native - AleutAH Alaska Native - HaidaAK Alaska Native - TlingitAM Alaska Native - TsimshianAN Alaska Native - Other/Unspecified AQ Alaska Native - InupiaqAS Alaska Native - SoutheastAT Alaska Native - AthabascanAY Alaska Native - Yup’ikBL Black or African AmericanIN American Indian (Not Alaska Native) NH Native Hawaiian or Other Pacific Islander SI AsianWH White
* Requested for compliance with Title IV of the Civil Rights
3 VETERAN/MILITARY STATUS
Code DescriptionBlank Non-veteranFMAI UAF Air Force StudentFMAR UAF Army StudentFMCO UAF Coast Guard StudentFMDP UAF Military DependentFMIL UAF Military StudentFMMA UAF Marine Corps StudentFMNA UAF Navy StudentFVDP UAF Veteran DependentFVET UAF Veteran Student
4 INFORMATION RELEASE
FERPA
The Office of Admissions and the Registrar is responsiblefor keeping student education records. The full copyof the university’s policies regarding access to studentrecords under the Family Educational Rights and PrivacyAct of 1974 (FERPA) are available at www.alaska.edu/studentservices/ferpa/.
Directory Information
The university may release certain directory informationto the public on a routine basis unless a student requests,in writing, that the university not release it. Forms torequest that directory information not be released areavailable in the Office of Admissions and the Registrar.No directory information will be released until the lastday of late registration. Any request to withhold directoryinformation will continue until a student providespermission, in writing, for the university to release such.After that, information will be released when appropriate.The names of students who have requested their directoryinformation be withheld will not appear in the publisheduniversity chancellor’s and dean’s lists.The following is considered directory information:
1. Name2. Email address3. Home city and state4. Weight and height of students on athletic teams5. Dates of attendance at UAF6. Program/major field(s) of study7. Degrees and certificates received, including dates8. Participation in officially recognized university
activities9. Academic and co-curricular honors, awards and
scholarships received, including dates
5 LATE PAYMENT/REINSTATEMENT FEES
An additional $100 fee will be added to accounts which are not paid by the withdrawal deadline. The university may drop you for non-payment.For more information about fees, contact the Office of the Bursar at 907-474-7384.
Office of Admissions and the Registrar, 102 Signers’ Hall • PO Box 757480, Fairbanks, Alaska 99775800-478-1823 • 907-474-7500 • 907-474-7097 (fax) [email protected] • [email protected]
Act of 1964.
P___
FERPA RELEASE FORM RECEIVED
Office use only
SID labelOffice use only
I give permission to the University of Alaska to release the selected information to the recipient listed for the purpose of:
Government issued picture ID is required with this form.If mailed or faxed, an enlarged copy of your official ID with a signature is required.
(i.e. providing access to parents, scholarship application, reimbursement from employer or other source, etc.)
Last First Middle Initial UA ID No.
Mailing Address
City State Zip
Phone No.
Email Address
Student Information
Types of Information to ReleaseAll Records
Accounting Includes tuition and fee balances, financial holds, mailing and billing address, payment plans, accounting statements and collections and debt information.
Admission Includes dates of application, programs selected, documents received, documents pending, dates of admission, admission status and conditions of admission.
Registration Includes current enrollment, dates of enrollment activity, enrollment status, residency status, semesters attended and mailing address information.
Academic Includes courses taken, grades received, GPA, academic progress, honors, transfer credit awarded and Records degree(s) awarded.
Financial Aid Includes all general financial aid information.
Page of
Release To
Release To
Release To
Release To
Cancel
Cancel
Cancel
Cancel
Check One:
Individual’s Name
Individual’s Name
Relationship:Releasee:
Relationship to Student
Relationship to Student
Relationship to Student
Relationship to Student
Student Signature Date
Authorization
ID Type Verified By: DateOffice use only
Individual’s Name
Individual’s Name
Office of Admissions and the Registrar907-474-7500
[email protected] • [email protected]
Office of the Bursar907-474-7384
Office of Financial Aid907-474-7256
General Information
The Family Educational Rights and Privacy Act (FERPA) deals specifically with the education records of students, affording them certain rights with respect to those records. For purposes of definition, education records are those records which are
1) directly related to a student and2) maintained by an institution or a party acting for the institution.
FERPA gives students who reach the age of 18, or who attend a postsecondary institution, the right to inspect and review their own education records. Furthermore, students have other rights including the right to request amendment of records and to have some control over the disclosure of personally identifiable information from these records.
FERPA applies to all educational agencies and institutions that receive funding under most programs administered by the Secretary of Education (34 C.F.R. 99.1). Almost all postsecondary institutions, both public and private, generally receive such funding and must, therefore, comply with FERPA.
Under FERPA, students are given three primary rights. They have the right to: inspect and review their education records; have some control over the disclosure of information from their education records; and seek to amend incorrect education records.
Electing FERPA ConfidentialityThe university may release certain directory information to the public on a routine basis unless a student requests, in writing, that the university not release it. Requests for non-disclosure remain in effect until a subsequent written request to release directory information is received.
Students who request non-disclosure of directory information* Will not have name printed in the published university chancellor’s and dean’s lists or commencement program.* Will not have attendance and/or degree verified for employers, insurance companies, etc.* Will only be able to discuss their UA Accounts in person with photo ID.
***PLEASE NOTE***
If you choose to elect the “confidentiality” option for your educational records, information for you will be withheld from a variety of sources, including: you - the student. This also includes friends, relatives, prospective employers, and the news media. Each student is advised to carefully consider the consequences of a decision to elect “confidentiality”. Once elected the University cannot acknowledge the existence of, or release information about, the record of any student who has elected confidentiality. (You can change this election at any time -- see How to Elect FERPA Confidentiality at UAOnline.) No information or services will be available to you via telephone if you have elected the confidentiality option. Your only options for conducting business transactions with the University would be in person, after presenting a valid photo ID, or through secure login on UA systems.
