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Select all that apply to you (Applicant must meet all criteria listed to be eligible for Wyoming Works funding.)

I plan to begin enrollment or will continue enrollment in this program on

I authorize Eastern Wyoming College to collect and share, at a minimum, personally identifying information, collected through the college's admission or state grant application, the FAFSA, or other method, enrollment information, and all other information necessary to determine my eligibility for a student grant (including past receipt of student grants or other state financial aid receipts) with other Wyoming Community Colleges and the Wyoming Community College Commission for the purposes of determining my eligibility for the Wyoming Works program.

I declare under the penalty of perjury that the information furnished is, to the best of my knowledge and belief, true, correct and complete.

Full Name*