HPOG is a study funded by the federal government which is being conducted to determine how these training opportunities help people improve their skills and find better jobs. During the study, all new eligible applicants will be selected by lottery to participate in these training opportunities. Not all eligible applicants will be selected to participate in these opportunities.
This document was supported by Grant 90FX0046 from the Administration for Children and Families, U.S. Department of Health & Human Services (HHS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HHS.
Click here if you have any Former/Other names
Armed Forces Americas
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District Of Columbia
Federated States of Micronesia
Northern Mariana Islands
*Ethnicity origin (or race):
*What gender are you?
*Are you a veteran?
*Are you a US Citizen?
Permanent Resident Card Number:
*Place of birth:
*Do you receive TANF cash benefits?
*TANF Grant Per Month?
Community Service Office:
*Do you receive basic food (food stamps)?
To be eligibile for PSH, family taxable income cannot exceed 70% of the Lower Living Standard Income Level based on the preceding year. Copies of official federal tax records for the preceding year may be required for veriication.
*Monthly Family Gross Income:
*Are you employed?
*Name of Employer?
*How many hours per week?
*Wages per hour?
*Are you CURRENTLY receiving unemployment benefits?
*Have you received unemployment benefits in the last 24 months?
List other sources on income:
Are you enrolled in any of these programs? (select all that apply)
Workforce Investment Act
In School/Out School WIB
As required by apply for Nursing Assistant Certification in Pennsylvania and as a condition of employment in health care, PSH conducts an in-depth criminial background check on each applicant. For additional information about state requirements, visit the
Nurse Aid Training Program
*Have you ever been convicted, entered a plea of guilty, no contest or a similar plea, or had prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction?
*Are you now subject to criminal prosecution or pending charges of a crime in any state or juristiction?
*Other than any matter above, is there any fact or circumstance involving you and your background that would call into question you being entrusted with the care, guidance, or supervision of vulnerable adults, young people, or developmentally disabled persons?
Personal & Family Needs & Support Systems
*Number of people in household:
*Number of children under 18 in your family:
Ages of your children:
*Is transportation a problem?
*Will you need assistance with transportation?
*Do you have a high school diploma?
*Highest grade completed?
If you will graduate in the next 6 months, click here.
*Name/Location of high school:
*Did you earn a GED?
*Name/Location of granting insitution:
If you will graduate with a GED in the next 6 months, click here.
*Have you attended CCAC?
Student ID Number:
*Do you have student loan debt?
How much do you owe and the name of the school:
Please list all training, classes or certificates since High School or GED:
*Have you ever worked in a health care job?
Name and location of employer:
*Who referred you to the HPOG Pathways to Success program?
City of Pittsburgh Housing Authory
Allegheny County Housing Authority
Womens and Girls Foundation
I have read the information contained in this application. I certify the information given is true and correct. By clicking below and submitting, I authorize the Community College of Allegheny County PSH Grant program to:
Conduct background checks and obtain any and all information needed to process my application.
Share necessary information with college staff at CCAC, community partners and any governmental entity and law enforcement agency.
Click here to agree to the above authorization.
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