APPLICATION PROCESS CHECKLIST
 STEP 1: ASK YOURSELF: Is this program right for me?
 Have you reviewed the Cyber Defense Certificate program schedule?
 Are you available for evening classes from 6:30 p.m. — 9:20 p.m., Tuesday and
Thursday (5:30 – 9:30 for two courses)?
 Are you available to take classes at Harford Community College?
 Are you comfortable with this training providing you employment
opportunities at the entry level?
 Can you commit to complete the full program, January 2016—
December 2016?
Do you meet all the initial requirements?
 Are you at least 18 years of age and eligible to work in the United States?
 Are you a member of one of the targeted groups for this grant (TAA
displaced, Unemployed, Underemployed, Veteran, or Minority)?
 STEP 2: COMPLETE INITIAL APPLICATION STEPS:
 HCC: Apply to HCC online at http://www.harford.edu/admissions/apply-now.aspx
Please be sure to fulfill all HCC admission requirements
 FAFSA: Apply for FAFSA Financial Aid at https://fafsa.ed.gov/
Required if you wish to receive federal funding.
 STEP 3: GATHER YOUR DOCUMENTATION:
 Age and Identity: Driver's license, passport, or photo ID
 Authorization to work in the United States.
 Veteran status: If you are a veteran, provide Form DD-214 or Veteran’s

Administration letter or records.
Transcripts: If you have attended a college other than HCC, please provide a
transcript of any classes taken.
 Testing: All students must be assessed for proficiency in English, Reading,
and Mathematics. Proficiency tests may be waived for students who can
establish eligibility requirements through prior education or other test
results.
 STEP 4: SUBMIT ALL DOCUMENTS TO:
Christine Brown, Career Navigator, Harford Community College. If you have
any questions, please contact Christine at 443.356.0363 or
chbrown@harford.edu.
Date: _______________ Student ID: _____________________
CPAM # _________________
Signature
I certify that the information I provide here is accurate:
Applicant Signature
Date
Contact Information
Full Name:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
State
Phone:
ZIP Code
Email:
Personal Information
Do you have a documented
disability?
 Yes
 No
Are you a United
States Citizen:
 Yes
 No
Permanent
Resident Alien:
 Yes
 No
If yes, list country of
citizenship and
registration number:
Race/Ethnicity (check all that apply):  Hispanic/Latino  American Indian/Alaskan Native  Asian  Black/African American
 Hawaiian/Other Pacific Islander  White
Social Security #:
Gender:
 Male
 Female
DOB:
Educational and Employment Information
Highest Level of Education Attainment (select one):
 GED  H.S. Diploma  Some College  Associate’s Degree  Bachelor’s Degree  Graduate Degree
Please identify the program of study you are currently enrolled in (select one):
 Full-time Student
 1-Year Cyber Certificate  Associate’s Degree  Non-credit program  Other  Part-time Student
Do you have, or are you
eligible for, a Pell Grant?
 Yes  No
Are you currently receiving benefits under the Trade Adjustment Assistance program?  Yes  No
Are you currently employed?  Yes  No
Employer Name
Underemployed?
 Yes  No
Hours per week Salary
Start Date
Work Phone
If yes, Reason:  Working part-time
 My earnings are less than $19.96/hr with benefits or $21.78/hr without benefits
 Working full-time, but duties and/or salary are not commensurate with my skill level
 Working full-time, but duties and/or salary are not commensurate with my educational level
Veteran Status
 I am not a veteran
 I am the spouse of a veteran
 I AM a veteran
Branch of Service
Date of Discharge
Type of Discharge
Do you have a documented service-related disability:  Not a disabled veteran  < 30% disability rating  ≥ 30% disability rating
 I received copies of the “Grievance Procedures” and “Veteran’s Priority of Service” policies.
Grant Funded Student’s Authorization to Disclose Information from Education Records
In accordance with the Privacy Act of 1974 (Public Law No. 93-579, 5 U.S.C. 552a), you are hereby notified that the Department of Labor
is authorized to collect information to implement the Trade Adjustment Assistance Community College and Career Training Program
under 19 USC 2372 – 2372a. The principal purpose for collecting this information is to administer the program, including tracking and
evaluating participant progress. Providing this information, including a social security number (SSN) is voluntary; failure to disclose a SSN
will not result in the denial of any right, benefit or privilege to which the participant is entitled. The information that is collected on this form
will be retained in the program files of the grantee and may be released to other Department officials in the performance of their official
duties.
I understand that my educational records are protected by the Family Educational Rights and Privacy Act of 1974, and they may not be
disclosed without my prior written consent. I hereby consent to the disclosure of the following education records pertaining to me to the
persons and for the purposes as stated below:
I hereby authorize the following officials:
1. Harford Community College officials and faculty members teaching courses in which I am currently (or was) enrolled
2. Cyber Technology Pathways Across Maryland (CPAM), Employment Training Administration (ETA), Maryland Department of Labor,
Licensing and Registration (DLLR), Susquehanna Workforce Network and/or industry accrediting bodies to include, but not limited to:
CompTIA, Cisco, (ISC)²
to disclose the following:
1. demographic or contact information, which may include social security number and other personally identifiable information
2. employment status
3. financial information, including financial aid, student account balance, and Veterans benefits
4. academic records including, but not limited to placement test results, class schedule, interim and final grades, attendance, any
information regarding my academic progress prior to the final determination of grade, and professional certifications
to the following persons:
1. CPAM, ETA, DLLR and/ or Susquehanna Workforce Network staff members
2. Specific state and federal grant funders, lead agencies, fiscal administrators of grant programs
3. Harford Community College officials with a legitimate educational need to know
for the following purposes:
1. to monitor, assist and determine eligibility for grant-funded programs
2. to monitor and assist with respect to retention and student support needs related to programs within Student & Career Services
3. for reporting requirements of specific grant programs; as well as for statistical analysis of grant outcomes
4. to monitor and assist with graduate placement needs and employment outcome tracking
I understand further that:
1. such records may be disclosed only on the condition that the party to whom the information is disclosed will not re-disclose the
information to any other party without my written consent unless specifically allowed by law.
2. I have the right to not consent to the release of my educational records for these purposes only by initialing the box below.
3. I recognize that a copy of such records must be provided to me upon my request in writing to the Harford Community College Registrar.
4. this authorization remains in effect unless revoked by me in writing.
A copy of this authorization shall be considered as effective and valid as the original. By signing this form, I certify that I agree to the disclosure of
the records referenced above. This authorization and consent by me is valid for the life of the grant reporting period or until I revoke it in
writing.
PRINTED NA ME
HARFORD COMMUNITY COLL EGE
STUDENT SIGNATURE
RD
DATE
 I am opting out of signing this form and understand that I may not be eligible to receive grant-funded educational assistance because of this
decision.
PRINTED NA ME
HARFORD COMMUNITY COLL EGE
STUDENT SIGNATURE ***ONLY SIGN HERE I F YOU ARE OPTING OUT***
DATE
Checklist of Acceptable Source Documentation – USDOL Grants
Participant Name: _________________________________________________________________
Required Common Data Elements or Eligibility
Criteria
Examples of Acceptable Documentation
CPAM Intake Form
 CPAM Intake Form
Photo ID
 Driver’s License
OR
 Other Document issued by: _________________________________
U.S. Work Authorization: See page 2: List of
Acceptable Documents to Verify Employment
Authorization
 Verification of document(s) that satisfy List A OR
__________________________________________________ OR
 Verification of document(s) that satisfy List B and C
____________________________________________________
Social Security Number
 Social Security Card presented
Targeted Group:
TAA-Impacted
 Letter or form from State employment agency
Underemployed
 Employer statement or verification
 Self-Attestation
Not Employed
 Review of Unemployment Insurance wage records
 Self-Attestation
OR
Veteran Status
 Verification of DD-214
 Verification of Veteran’s Administration letter or records
 Spouse of Veteran
OR
Minority Status
 Gender
 Race/Ethnicity
OR
Student Release of Information
 Student Release of Information
Assessment Instruments
OR
 Test(s) administered ________________________________________
Scores: _____________________________________Date: ____________
Individual Employment Plan
 Individual Employment Plan
Cyber Defense Certificate Plan
 CDC Plan
Funding Source
 WIA  Contract Prepared
 TAA  Contract Prepared
 Submitted FAFSA Application  Pell Approved
 Other ____________________________________________________
Proof of Enrollment in Training
 Transcript
 Student record
 Other
Student Status
 Full-Time
 Part-Time
Case Notes
 Case Notes
OR
I certify that the documents checked above have been presented to me by the CPAM applicant. The documents have
been reviewed and confirm both program eligibility and the applicant’s legal right to work in the U.S.
Checklist completed by: _________________________________________ Date: ___________
Individual meets Eligibility Criteria for CPAM Consortium ____Yes
____No
STUDENT GRIEVANCE PROCESS
Introduction
The purpose of the General Grievance Process for Students is to provide a clearly stated, timely, and accessible method
of recourse to students who feel that a particular action or series of actions on the part of a Harford Community College
employee has violated accepted or stated institutional practices and standards. Student grievances appropriate to this
policy include, but are not necessarily limited to:



concerns regarding ethical and professional behavior of employees;
arbitrary application of current College policies by employees; and
perceived violations by College employees of accepted rights of students in institutions of higher learning such as
the right to free expression and the right to assemble.
This process is intended to be investigative rather than adversarial and is not to be used when the grievance involves
an alleged violation of the Student Code of Conduct, Sexual Harassment policy, Nondiscrimination policy, or to appeal
other institutional actions/policies which possess their own appeal process. Refer to the HCC College Catalog for these
procedures.
Procedures
Preceding Step 1, a student may consult with one of the Associate Vice Presidents for Student Development or an
Academic Dean to clarify the issues involved and identify the appropriate system for redress of the grievance. If the
student decides to proceed with the grievance process, he/she must adhere to the following procedures as outlined
below. Time limits may be extended by the supervisor with the jurisdiction over the grievance.
Step 1: Within ten (10) work days* of the occurrence of the issue/incident, the student must discuss the issue/incident
being grieved with the employee involved to seek resolution.
Step 2: If the student is not satisfied with the outcome of Step 1, the student may proceed with the grievance by
completing the "Student General Grievance Form" and submitting it to the employee's immediate supervisor within five
(5) work days of completing Step 1.
Step 3: Within seven (7) work days of receipt of the form, and to ensure a full understanding of all perspectives, the
supervisor or designee will: (1) discuss the issue with the involved employee and request a written account of the
incident; and (2), meet with and discuss the grievance with the student. The supervisor or designee may also call a
meeting with other parties to assist in resolution.
Within seven (7) work days of the meeting with the student, the supervisor or designee will inform the student and the
employee in writing of the decision.
Step 4: The student may appeal the decision in writing to the immediate supervisor's supervisor within five (5) work
days of the immediate supervisor's decision by sending a copy of the completed "Student General Grievance Form" to
the immediate supervisor's supervisor.
Step 5: Upon receipt of the written appeal, the supervisor's supervisor will review the matter and make a final decision
regarding the grievance, which will be communicated in writing to the student, involved employees, and immediate
supervisor within ten (10) work days of receipt of the written appeal. This decision is final and ends the appeal/grievance
process for the student.
*A work day is defined as a day when the College is open and does not include weekends or holidays when the College
is closed.
VETERAN’S PRIORITY OF SERVICE STATEMENT
The Jobs for Veterans Act (JVA), PL 107‐288, signed into law on November 7, 2002,
requires that there be priority of service for veterans and eligible spouses in any
workforce preparation, development, or delivery program or service directly funded in
whole or in part, by the U.S. Department of Labor (38 U.S.C. 4215).
Priority of service means, with respect to any qualified Department of Labor
employment and job-training programs, that veterans (1) and eligible spouses (2) shall
be given priority over non-veterans for the receipt of employment, training, and
placement services, notwithstanding any other provision of the law.
If you are a veteran or the eligible spouse of a veteran, you are entitled to priority
service throughout the duration of your participation in the Cyber Pathways Across
Maryland program (CPAM). This priority applies to any and all aspects of the program’s
services and facilities, and could include preferential class enrollment, and access to our
exclusive career and internship counseling, connections, and opportunities.
1 Veteran: a person who served in the active military, naval, or air service, and who
was discharged or released there from under conditions other than dishonorable. Active
service includes full-time duty in the National Guard or Reserve component, other than
full-time duty for training purposes.
2 Eligible Spouse: the spouse of any of the following:
1. Any veteran who died of a service-connected disability;
2. Any member of the Armed Forces serving on active duty who, at the time of
application for priority, is listed in one or more of the following categories and
has been so listed for a total of more than 90 days:
a. Missing in action;
b. Captured in line of duty by a hostile force; or
c. Forcibly detained or interned in line of duty by a foreign government or
power;
3. Any veteran who has a total disability resulting from a service-connected
disability, as evaluated by the Department of Veterans Affairs;
4. Any veteran who died while a service-connected disability (as described in
number 3 above) was in existence.