South Dakota Technical Institutes Critical Needs Workforce Scholarship

South Dakota Technical Institutes Critical Needs Workforce Scholarship Acceptance and Promissory Note for School Years 2014-15, 2015-16 and 2016-17

This form, and possibly other documentation requested by the Financial Aid Office, is required to validate and process Critical Needs Workforce Scholarship awards. Technical Institute: Choose an item. Program of Study: Choose an item.

First Name: Click here to enter text. MI: Click Last Name: Click here to enter text. Soc.Sec.No. Click here to enter text. Anticipated Enrollment Semester/Year: Click here to enter text. : Permanent Street Address: Click here to enter text. City, State, ZIP: Click here to enter text. Area Code/Phone: Click here to enter text. Email: Click here to enter text.

REFERENCES: Provide two separate references with different US addresses, completed in full. A parent (if living) or legal guardian should be listed first. First Reference Second Reference Name: Click here to enter text. Click here to enter text. Address: Click here to enter text. Click here to enter text. City, State, ZIP: Click here to enter text. Click here to enter text. Area Code/Phone: Click here to enter text. Click here to enter text. Email: Click here to enter text. Click here to enter text. Relationship: Click here to enter text. Click here to enter text.

CERTIFICATIONS AND AUTHORIZATIONS - Please read and hand-initial each statement below. Do not type initials. Under penalty of perjury, I certify that: The information I have provided on this form is accurate and complete. I will enter the program of study noted above which will prepare me for employment in a critical need occupation in SD. I will enroll and maintain full-time status as a student and maintain a cumulative grade point average of 2.0 or higher. I will repay this scholarship, including any applicable collection costs and attorney fees, if I do not complete the program. I will work in South Dakota in the field I received training in for 36 consecutive months following graduation. I have up to 6 months following graduation to secure a job in the field. If I do not begin employment in that field immediately following graduation, my 36 month employment commitment will begin as soon as I secure a job in the field. I will repay the appropriate portion of this scholarship if I do not fulfill employment requirements for 36 months following graduation. I authorize the technical institute where I am enrolled and the SD Department of Education and its agents to release information about me to certify and validate that I am eligible for the scholarship. I authorize the technical institute where I am enrolled, the SD Department of Education and the Governor of SD to release my name and the name of my high school when announcing the critical needs scholarship recipients. I authorize the technical institute where I am enrolled to release pertinent information regarding this scholarship to the references listed above unless I submit written direction otherwise. I authorize my employer(s) to release information to document my employment in the critical need occupation. I will provide necessary information 12, 24 and 36 months following graduation to document my employment in the critical need occupation. I have read the information on page 2 of this Acceptance & Promissory Note and understand I will be bound by the terms and agreements outlined.

Please submit this completed form to the Financial Aid Office of the technical institute in which you will attend. Make a copy for your records.

I understand that by submitting this Acceptance and Promissory Note I am obligated to meet the eligibility and employment conditions outlined above. My failure to do so will result in me repaying the appropriate portion of the critical needs scholarship. Student Signature Date CRITICAL NEEDS SCHOLARSHIP PROGRAMS The following technical institute programs of study have scholarships available: LAKE AREA TECHNICAL INSTITUTE MITCHELL TECHNICAL INSTITUTE SOUTHEAST TECHNICAL INSTITUTE WESTERN DAKOTA TECH  Energy Operations – AAS  Architectural Design & Building  Automotive Technician – AAS/Diploma  Computer Aided Drafting – Construction – AAS AAS/Diploma  Energy Technology – AAS CIS/Systems Administration – AAS  Automation Controls/SCADA – AAS   Precision Machining – AAS  Computer Science – AAS/Diploma  Electrical Utilities and Substation  Precision Machining eDegree – AAS  Civil Engineering Technology – AAS Technology – AAS  Electrical Trades – AAS Robotics eDegree – AAS   Electrical Construction & Maintenance –  Computer Network Security – AAS AAS/Diploma  HVAC Technology – Diploma  Computer Programming – AAS  Farm Power Technology – AAS  HVAC/R Technology – AAS  Heating & Cooling Technology –  Computer Science – AAS/Diploma AAS/Diploma  Network Administration & Security –  Diesel Technology – AAS/Diploma AAS/Diploma  Industrial Controls – Certificate  Industrial Maintenance Technology –  Electronics Technology – AAS/Diploma  Precision Machining – AAS/Diploma Diploma  Transportation Technology – AAS  Information Systems Technology –  Land Surveying Science Technology – AAS/Diploma AAS  Welding – AAS/Diploma  Precision Technology Specialist –  Mechanical Engineering Technology – AAS/Diploma AAS  Telecommunications – AAS  Mechatronics – AAS  Welding & Manufacturing Technology – AAS/Diploma  Plumbing – Diploma

 Welding – Diploma

Once you receive a scholarship, the critical needs occupation remains eligible for meeting the employment requirement, even if the occupation ceases to be a critical workforce need in the state.

At its discretion, the technical institute where I am AGREEMENT  I cease full-time attendance without completing a enrolled may allow me to continue receiving my program of study leading to employment in the  I understand and agree that in the event I fail to scholarship if my enrollment status temporarily changes. meet the scholarship eligibility requirements, I will critical need occupation, or no longer be eligible for additional funds and I will  I am unsuccessful in completing my program of REPAYMENT BEGIN DATE be required to repay my scholarship. study at the technical institute where I am enrolled If I fail to meet the terms and agreement of the  I understand and agree that if I fail to be employed including withdrawal, unsatisfactory academic Acceptance and Promissory Note, repayment will begin 6 in my training area or do not continue employment performance or conduct, or other factors due to my months following that date. Payment will be made to the in the critical need occupation for 36 months, I will performance that prohibit me from continuing or technical institute in which I am enrolled and will include repay the appropriate portion of this scholarship. If graduating in the program, or outstanding principal, applicable collection costs and reasonable attorney’s fees. The technical institute in I begin employment in the critical need occupation  I graduate but do not obtain employment in the and leave before 36 months are complete, I will which I am enrolled will provide me with the repayment critical need occupation within 6 months in South amount for which I must make regular payments. I must repay a prorated amount according to the policy of Dakota, or the technical institute where I received the make repayment regardless if I regularly receive a bill or scholarship.  I cease employment in the critical need occupation repayment notice. in South Dakota without completing my  I agree to inform the technical institute where I am employment obligation, or There will be no penalty for prepaying any portion and all enrolled within 10 days of any changes affecting my payments will be applied in the following order: enrollment status, employment status, name or  I fail to fulfill the terms and agreements of the Fees and collection costs address. Acceptance and Promissory Note. 1. 2.Outstanding principal  The SD Department of Education or its agents may If I fail to make full payments, reasonable charges incurred obtain enrollment and address information from for the collection and/or enforcement of this promissory DISCHARGE any of the agents of the technical institute where I note will be added to my repayment including, but not My repayment obligation will not automatically be plan to be enrolled, am enrolled, or was enrolled. limited to, reasonable attorney’s fees and collection costs discharged in bankruptcy. I understand that this grant is as determined by the technical institute where I am educational and may be made in part through a non-profit REPAYMENT enrolled. I further understand that repayment will be required if: organization, and as such, may not be dischargeable in bankruptcy, except pursuant to 11.U.S.Code 523(a)(8).

3 The technical institute I am enrolled in does not vouch for ACCELERATION AND DEFAULT  I fail to make payment when due, provided my the quality or sustainability of the academic programs At the option of the technical institute in which I am failure has persisted for at least 270 days, or offered. I understand I must repay the scholarship even if I enrolled, the entire unpaid balance will become do not complete my education, am unable to obtain immediately due and payable (also called “acceleration”)  I fail to comply with other terms, and the technical employment in my field of study within 6 months of if I: institute in which I am enrolled reasonably graduation, or I am dissatisfied with, or do not receive, concludes I no longer intend to honor my the education for which I paid. It is my responsibility to  Make a false representation that results in my repayment requirement. Principle balance, secure a job in a critical need occupation in South Dakota. receiving a scholarship for which I am not eligible or applicable collection fees and reasonable attorney  Default costs will become immediately due and payable. The technical institute I am enrolled in may cancel my employment and/or repayment requirement, at its The following events shall constitute a default: If I default, the default will be reported to all national discretion, due to hardship. credit bureaus and will significantly and adversely affect  I fail to pay the entire unpaid balance, my credit history. PRIVACY NOTICE The information provided in this Acceptance and Promissory Note will be shared and released per the Certifications and Authorizations section. Your Social Security Number will be used as an account identifier and, should your critical needs workforce scholarship become payable, this information will be used in the servicing and collection of the loan.

TECHNICAL INSTITUTE USE Scholarship Amount: Program CIP Code:

Scholarship Awarded for School Year(s):

CONTACT YOUR TECHNICAL INSTITUTE’S FINANCIAL AID OFFICE

1201 Arrow Avenue PO Box 730 Watertown, SD 57201 605.882.5284 or 800.657.4344 https://www.lakeareatech.edu/future/financialaid/financialaid.html

1800 East Spruce Street Mitchell, SD 57301 605.995.3052 or 800.684.1969 http://www.mitchelltech.edu/financialaid/

2320 N Career Avenue Sioux Falls, SD 57107 605.367.7624 or 800.247.0789 http://www.southeasttech.edu/futurestudents/financialaid/

800 Mickelson Drive Rapid City, SD 57703-4018 605.394.4034 or 800.544.8765 http://www.wdt.edu/financial-aid/