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Western Dakota Tech 800 Mickelson Dr. Rapid City, SD 57703-4018 PHONE: 605-394-4034 or 800-544-8765 FAX: 605-394-2204 2016-2017 OTHER FUNDING SOURCES WORKSHEET You have indicated on your admissions application that you are a veteran, may have other funding sources, or both. Please complete the applicable sections below and submit the form to the financial aid administrator at WDT. If you have questions please contact us by phone at 605-394-4034 or 800-544-8765 or by e-mail at [email protected] SECTION A: STUDENT INFORMATION ___________________________________________________ Western Dakota Tech ID-Number _______________________________________________ First Name _____XXX-XX-_____________________ SSN (Last Four Digits) ________________________________________ Last Name ____________________________________________________________________________________________ Mailing Address City State Zip ____________________________________________________________________________________________ Phone Number Cell Phone Email SECTION B: OTHER FUNDING SOURCES Please indicate if you are applying for, or will receive, any of the other resources listed below. Our office may need to complete additional information on your behalf for you to receive them. Failure to notify us may delay receipt of your funds. If you are unsure of the amount you will receive please indicate it’s an estimate. If you have applied for funding but are not sure you will receive it, please mark the amount as pending. If you need more room, please attach a sheet containing your name and student ID. Place an (X) in front of each source for which you are applying, or will receive. Funding Source ☐ Chapter 16, 30, 31, 33 or 35 VA Benefits ☐ National Guard Education ☐ VA Vocational Rehabilitation ☐ Vocational Rehabilitation ☐ Bureau of Indian Affairs – Monthly Living Stipend ☐ Bureau of Indian Affairs – Education Funding ☐ Employer-Paid Benefits ☐ Workforce Investment Act (WIA) ☐ Outside scholarship* ☐ Outside scholarship ☐ Outside scholarship ☐ Other ☐ Other ☐ Other ☐ Other *Scholarships from organizations other than WDT. Dollar Amount SECTION C: CERTIFICATION AND SIGNATURE I certify that all of the information reported on this worksheet is complete and correct. The student must sign and date this worksheet. _________________________________________________ Print Student’s Name ______________________________ Student’s ID Number _________________________________________________ Student’s Signature _______________________________ Date Submit this worksheet to the Financial Aid Office. You may also scan and email this document to [email protected] OR fax to 605-394-2204. Contact Information for Other Funding Sources Veterans Administration (VA) and National Guard Veterans and/or dependents of veterans who are disabled or deceased may qualify for one of the programs of financial assistance for school purposes through the Veterans Administration. Contact the Veterans Administration Center, Box 5046, Sioux Falls, SD 57117 (toll free 1-800-827-1000) or students can also contact their local County Veterans Service office for more information (Veterans Service, Public Service Building, 725 North LaCrosse Street, Rapid City, SD 57701, (605) 394-2266). Members of the South Dakota National Guard may be eligible for National Guard educational benefits; students should contact their units to determine eligibility and certification procedures. Vocational Rehabilitation The Vocational Rehabilitation program is intended to assist those students with physical and/or mental disabilities to become active members of the labor market. The Service to the Visually Impaired is also a special section of the Division of Rehabilitation Services. It provides assistance to those individuals who experience some type of visual disability. Students who think they may qualify are encouraged to contact their local office of the South Dakota Division of Rehabilitation Services at 111-A New York St., Rapid City, SD 57701, (605) 394-2261. Bureau of Indian Affairs (BIA) The Employment Assistance Program of the Bureau of Indian Affairs assists diploma students who reside on or near the reservation to enroll in and pay for vocational education programs. Students must be of ¼ or more Native American descent. The student is expected to apply for other types of aid. The amount of this aid may be deducted from the eligible amount of Employment Assistance. Students must contact the BIA office for which they are registered for application materials and deadlines. Workforce Investment Act (WIA) The Workforce Investment Act of 1982 established a program to provide comprehensive services, which include the training, education, and other services needed to enable individuals to secure and retain employment. Eligible students may receive assistance in meeting direct school costs at WDT. Student are encouraged to contact the SD Career Services Office. In Rapid City, call (605) 3942325. Scholarships and Grants It is through the generosity and kindness of many organizations that WDT is able to inform students of opportunities for funding their education. Scholarship amounts and deadlines vary, and funding for scholarships is purely voluntary ~ funding may increase and/or decrease from year to year. Please visit the scholarship page on WDT’s website at www.wdt.edu for a listing of available scholarships and applications.