Carl Perkins Reimbursement Clinical Health Requirements Application

Due to some technical errors, Perkins funding applications have been updated for the current term.  If you are accessing this application via old links, the forms may not be forwarded correctly.  Please visit for updated applications.

Grant to provide assistance with Immunizations, Physical Exams, CPR, Background Checks, and Drug Screens to target special population health science students enrolled in clinical courses.

A copy of your paid fee receipt/class schedule must accompany application.

You may be retroactively reimbursed up to 90 days for expenses.

Do any of the following unique and/or special circumstances apply to you? (Check any or all that apply)
I am seeking reimbursement for the following (check all that apply)

At this time, tuition reimbursements are not being sponsored by the grant.

Release of Records

I approve release and/or review of my personal school records. I understand fully that my attendance in college courses must be in compliance with school policy and that I may be dropped from the Clinical Health Requirements Reimbursement Program at any time if my attendance is poor.

I understand that Transportation Reimbursement is only available during the time that I am in class. If I drop any of my college courses, for any reason, I must notify the Dean’s Office immediately. If this affects my transportation reimbursement status, the award will be modified accordingly.

Failure to report any changes will result in immediate termination from the program.

Inconsistent class attendance will result in termination from the Clinical Health Requirements Reimbursement Program.

If at any time I become ineligible under the terms of the program, or if funds are withdrawn from the grant program, I understand that I will be responsible for any transportation charges incurred after the date I become ineligible or after the funds are withdrawn.

I must maintain, each semester, a GPA of 2.0 or higher as well as an overall GPA of 2.0 or higher.

I fully understand, confirm, and agree to the above conditions for services through the Clinical Health Requirements Reimbursement Program.

I have read and agree to comply with the Clinical Health Requirements Reimbursement Program provisions. I understand that failure on my part to comply with any of the provisions could result in loss benefits provided. All Clinical Health Requirements Reimbursement is contingent upon available funding.

Acceptance of Award

I wish to apply for the Clinical Reimbursement Program at San Jacinto College. I have read the Rules and Regulations and have fulfilled the requirements that apply to me.

Please acknowledge you have read the statement below by checking the box provided next to each statement.

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