Will County Heroes Teaching and Nursing Grant Program Application

School/College Information

School:

School Address:

Country

Street

City

Region

Postal Code

Student Information

GovState Student ID Number:

First Name:

Last Name:

Address:

Country

Street

City

Region

Postal Code

Mobile Phone Number:

Email Address:

Program of Study (Major):

Entry Term:

Entry Year:

ARPA Aid:

Total Aid Package:

Note: American Rescue Plan Act (ARPA) aid may not exceed or supplant other available funding sources. ARPA is available to complete and/or fund the gap in a student’s total aid package. https://hfs.illinois.gov/info/arpa-payments.html

Attestation and Signature

I attest that I qualify based on the following selection for the financial incentive to complete a teaching or nursing program. I acknowledge that I will be accepting assistance for an education program as a student who wants and is available for work, and this incentive will enable me to complete the necessary job training to enter my chosen field.

This program is available to impacted students which must qualify and attest to “ONE” of the following qualify and attest to “ONE” of the following.

Low or moderate income (see guidelines below)

Experienced unemployment

Qualify and/or receive Medicaid, Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Medicare Part D Low-Income Subsidies, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Section 8 Vouchers, Low-Income Home Energy Assistance Program (LIHEAP), and Pell Grants

Guidelines:

U.S. Treasury states that income at or below 300 percent of the Federal Poverty Guidelines for the size of the household based on the most recently published poverty guidelines meets the definition of
“impacted”. Please reference the income table below:

Household Size	Income
1	$40,770
2	$54,930
3	$69,090
4	$83,250
5	$97,410
6	$111,570

Guidelines-2022.pdf (hhs.gov)

Signature:

Date: