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Pennsylvania Targeted Industry Program
(PA-TIP) Student Application ■ 2013-14 AWARD YEAR
INSTRUCTIONS AND INFORMATION:
The following information is needed so that your application can be considered for the Pennsylvania Targeted Industry
Program (PA-TIP). If you need further information please feel free to contact The Pennsylvania Higher Education
Assistance Agency (PHEAA) staff at 800.692.7392 (TDD for hearing impaired ONLY: 800.654.5984) or by email at
patip@pheaa.org. You may also visit our website at PHEAA.org/PA-TIP.
STUDENT ELIGIBILITY REQUIREMENTS:
In order to qualify for PA-TIP, applicants must:
• Be a domiciliary of Pennsylvania.
• Have received a high school diploma, GED or recognized homeschool certificate.
• File a Free application for Federal Student Aid (FAFSA) for the award year for which PA-TIP funds are being requested.
• Complete and return to PHEAA the 2013-14 PA-TIP application by April 1, 2014.
• Be enrolled at least half-time at an institution approved by PHEAA for participation in PA-TIP. Full-time is defined as at
least 12 credits or 450 clock hours per enrollment period. At least half-time is defined as a minimum of 6 credit hours
or 225 clock hours per enrollment period.
• Not be in default or pending default on an educational loan or owe a State Grant refund.
• Not be receiving a Pennsylvania State Grant for the program of study.
• Have financial need as determined by the program guidelines and certified by the school
• Be enrolled in an eligible program of study (see Pages 3-4) that is at least 10 weeks but less than two academic years
in length.
• Supply a copy of the DD214 Form if the applicant is a veteran of the U.S. Armed Forces and was honorably discharged.
INFORMATION ON THE PRIVACY ACT AND THE USE OF YOUR Social Security Number:
The Privacy Act of 1974 requires that each federal, state or local agency that asks for your Social Security Number or
other information must tell you the following:
1. The agency’s legal right to ask for the information and whether the law says you must give it;
2. What purpose the agency has in asking for it and how it will be used; and
3. What could happen if you do not give it.
The number is needed to be sure we know who you are, to process your application, and to keep track of your record. We
use your Social Security Number in recording information about your college attendance and to document all information
relevant to PA-TIP, including sharing it with the Pennsylvania Department of Labor & Industry in order to exchange postschool
separation employment information; and in making sure you have received the benefit of this waiver. If you do not
give us your Social Security Number, you will not receive a PA-TIP award.
PA-TIP applicants are hereby advised that disclosure of their Social Security Number is a requirement and a condition for
participation in PA-TIP. PHEAA, without such an identifier, would have difficulty in maintaining proper program records.
Section 7(a)(2) of the Privacy Act provides that an agency may continue to require the disclosure of an individual’s Social
Security Number where the agency required this disclosure under statute or regulations prior to January 1, 1975, in
order to verify the identity of the individual. Beginning in 1966 with Form S-1A-66 (Fist Application), applicants have been
required to answer all questions completely or face disqualification for grant assistance. All subsequent forms utilized
by PHEAA contain the Social Security Number as the identifier of the applicant, including eligibility announcements
forwarded to the financial aid officer of the postsecondary institution.
Mail or fax all required documentation by April 1, 2014 to:
PHEAA, State Grant and Special Programs • P.O. Box 8157 • Harrisburg, PA 17105-8157 • Fax: 717.720.3786
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Pennsylvania Targeted Industry Program
(PA-TIP) Student Application ■ 2013-14 AWARD YEAR
PLEASE PRINT
Last Name: First Name: MI: Social Security Number:
Address (P.O. Box must be accompanied by a street address): City: State: ZIP:
Are you a veteran of the U.S. Armed Forces: n YES n NO If Yes, please provide a copy of your DD214.
Telephone Number:
Home:
Other:
Institution you will attend for 2013-14:
Email Address:
Date of Birth:
Institution Street Address: City: State: ZIP:
Program of study (corresponding Classification of Instructional Program (CIP) codes begin on Page 3).
Please list both the CIP code and the corresponding description:
Estimated date program of study
begins:
What is your enrollment status n Full-Time n Half-Time n Other (please specify):
By signing this application, I/we authorize PHEAA to make public announcement of any PA-TIP award or rejection of PA-TIP award made to the applicant, and to forward to the institution which
the applicant listed (or subsequently indicates that the applicant may attend) all information on any application and all information subsequently submitted to or acquired by PHEAA. I/We also
authorize PHEAA and the Pennsylvania Department of Labor and Industry (L&I) and the Pennsylvania Department of Education (PDE) to share information in their respective possession among each
other regarding this application and any other information related to applicant’s participation in PA-TIP, regardless of whether such information is the applicant’s non-public personally identifiable/
confidential information (including, without limitation, PA-TIP award, PA –TIP rejection, information related to applicant’s progress, completion and/or non-completion of the PA-TIP program of study,
and post-school separation employment information). I/We declare under penalty of the criminal laws of the Commonwealth of Pennsylvania that the application has been examined by me/us and
to the best of my knowledge and belief, is a true, correct and complete application (see 24 P.S. § 5158.1 and 18 Pa.C.S.A. § 4904). I/we agree that the awarding of PA-TIP awards is based on various
factors including available resources and that I/we may or may not receive a PA-TIP award regardless of eligibility for a PA-TIP award.
Signature of Applicant:
Date Signed:
Parent or Legal Guardian Signature:
(Required only if the applicant is less than 18 years of age)
Date Signed:
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Pennsylvania Targeted Industry Program
(PA-TIP) Student Application ■ 2013-14 AWARD YEAR
Eligible Classification of Instructional Program (CIP) Codes:
CIP Code CIP Title
49.0101 Aeronautics/Aviation/Aerospace Science &
Technology, General
01.0401 Agricultural & Food Products Processing
01.0902 Agricultural Animal Breeding
01.0199 Agricultural Business & Management, Other
01.0205 Agricultural Mechanics & Equipment/Machine
Technology
01.0299 Agricultural Mechanization, Other
01.0301 Agricultural Production Operations, General
01.0399 Agricultural Production Operations, Other
01.9999 Agriculture, Agriculture Operations & Related
Sciences, Other
01.0000 Agriculture, General
01.0308 Agroecology & Sustainable Agriculture
01.1102 Agronomy & Crop Science
01.0904 Animal Nutrition
01.0901 Animal Sciences, General
01.0302 Animal/Livestock Husbandry & Production
01.0303 Aquaculture
49.0104 Aviation/Airway Management & Operations
46.0499 Building/Construction Finishing, Management &
Inspection, Other
46.0401 Building/Property Maintenance
15.1302 CAD/CADD Drafting and/or Design Technology/
Technician
41.0303 Chemical Process Technology
41.0301 Chemical Technology/Technician
47.0103 Communications Systems Installation & Repair
Technology
48.0510 Computer Numerically Controlled (CNC) Machinist
Technology/CNC Machinist
46.0000 Construction Trades, General
49.0202 Construction/Heavy Equipment/Earthmoving
Equipment Operation
01.0304 Crop Production
CIP Code CIP Title
01.0306 Dairy Husbandry & Production
01.0905 Dairy Science
47.0605 Diesel Mechanics Technology/Technician
15.1301 Drafting & Design Technology/Technician, General
46.0301 Electrical & Power Transmission Installation/
Installer, General
46.0399 Electrical & Power Transmission Installers, Other
47.0101 Electrical/Electronics Equipment Installation &
Repair, General
47.0199 Electrical/Electronics Maintenance & Repair
Technology, Other
46.0302 Electrician
01.0104 Farm/Farm & Ranch Management
03.0301 Fishing & Fisheries Sciences & Management
03.0510 Forest Resources Production & Management
49.0299 Ground Transportation, Other
47.0201 Heating, A/C, Ventilation & Refrigeration Maint.
Technology
47.0302 Heavy Equipment Maintenance Technology/
Technician
47.0399 Heavy/Industrial Equipment Maintenance
Technologies, Other
01.0307 Horse Husbandry/Equine Science & Management
01.1103 Horticultural Science
47.0105 Industrial Electronics Technology/Technician
14.3501 Industrial Engineering
47.0303 Industrial Mechanics & Maintenance Technology
46.0414 Insulator
46.0303 Lineworker
01.0906 Livestock Management
52.0203 Logistics, Materials, & Supply Chain Management
48.0503 Machine Shop Technology/Assistant
48.0501 Machine Tool Technology/Machinist
47.9999 Mechanic & Repair Technologies/Technicians,
Other
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Pennsylvania Targeted Industry Program
(PA-TIP) Student Application ■ 2013-14 AWARD YEAR
Eligible Classification of Instructional Program (CIP) Codes: continued
CIP Code CIP Title
15.1306 Mechanical Drafting & Mechanical Drafting CAD/
CADD
15.0899 Mechanical Engineering Related Technologies/
Technicians, Other
15.0805 Mechanical Engineering/Mechanical Technology/
Technician
47.0000 Mechanics & Repairers, General
47.0613 Medium/Heavy Vehicle & Truck Technology/
Technician
48.0511 Metal Fabricator
41.0299 Nuclear & Industrial Radiologic Technologies/
Technicians, Other
41.0205 Nuclear/Nuclear Power Technology/Technician
52.0205 Operations Management & Supervision
46.0502 Pipefitting/Pipefitter & Sprinkler Fitter
01.1101 Plant Sciences, General
46.0599 Plumbing & Related Water Supply Services, Other
46.0503 Plumbing Technology/Plumber
01.0907 Poultry Science
48.0599 Precision Metal Working, Other
48.0000 Precision Production Trades, General
47.0499 Precision Systems Maintenance & Repair
Technologies, Other
49.0208 Railroad & Railway Transportation
48.0506 Sheet Metal Technology/Sheetworking
15.0505 Solar Energy Technology/Technician
48.0507 Tool & Die Technology/Technician
49.9999 Transportation & Materials Moving, Other
52.0209 Transportation/Mobility Management
49.0205 Truck & Bus Driver/Commercial Vehicle Operator
& Instructor
CIP Code CIP Title
47.0612 Vehicle Emissions Inspection & Maintenance
Technology/Technician
47.0600 Vehicle Maintenance & Repair Technologies,
General
47.0699 Vehicle Maintenance & Repair Technologies, Other
51.0808 Veterinary/Animal Health Techn. & Veterinary
Assistant
15.0614 Welding Engineering Technology/Technician
48.0508 Welding Technology/Welder
46.0504 Well Drilling/Driller
48.0701 Woodworking, General
48.0799 Woodworking, Other
GR-TIPST
022513
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