application for financial assitance

St. Augustine College
OFFICE of FINANCIAL AID
APPLICATION FOR FINANCIAL ASSITANCE
Academic Year 20
/20
SECTION A
Student’s Name
Last Name
First Name
SS#
Middle Name
Date of Birth
Month
Address
Day
Year
Telephone# (home)
(work)
Marital Status:
Single
Married
Are you a(n):
New Student
Are you planning to study:
Do you live with:
Separated
Transfer Student
Full-time
Parents
Active Student
Part-time
Not with Parents
SECTION B Dependent Students
Are your parents Employed?
Returning Student
With Relatives
SECTION C Independent Students
Yes
No
If yes, Employer
Are you Employed?
Yes
If yes, Employer
Address
Address
Tel. #
Tel.#
Monthly Income $
Monthly Income $
No. Of Dependent Children
No. Of Dependent Children
If no, indicate:
No
ADC/AFDC
Public Aid
If no, indicate:
ADC/AFDC
Public Aid
Other
Other
Monthly Amount Received $
Year College:
Monthly Amount Received $
Freshman
Financial Aid For:
Sophomore
Junior
Senior
ISAC
PELL GRANT
STAFFORD LOAN
CWS
SEOG
OTHER
List below all previously attended college and/or universities (most recent first):
Name
Location
Dates Attended
Degree Earned
Name
Location
Dates Attended
Degree Earned
Name
Location
Dates Attended
Degree Earned
Under penalty of perjury, I declare that I will use
any funds I receive under the Pell Grant,
Supplemental Educational Opportunity Grant,
Stafford (GSL) Loan and College Work Study
(CWS) Program, solely for expenses connected with
attendance at St. Augustine College. I further
understand that I am responsible for repayment of
any portion of payments which cannot reasonably
be attributed to meeting educational expenses
related to attendance at St. Augustine College or
any other institution, and I am not in default on a
loan received for attendance at St. Augustine
College or any other institution.
I certify under penalty of perjury, that the foregoing
is true and correct.
Bajo pena de perjurio, declaro que usaré cualquier
suma de dinero que reciba de la Beca Pell, Beca
Suplemental de Oportunidad Educacional, Préstamo
Stafford (GSL), y Programa de Estudio y Trabajo,
solamente para gastos relacionados con mi
asistencia a St. Augustine College.
Además,
entiendo que soy responsable por el reembolso de
cualquier porción de pagos que no puedan ser
razonablemente atribuidos a gastos educacionales
relacionados con mi asistencia a St. Augustine
College. Afirmo con pleno conocimiento que no
adeudo dinero alguno por concepto de reembolso de
ninguna beca en St. Augustine College u otra
institución universitaria, y no estoy en deuda de
ningún préstamo recibido por mi asistencia en St.
Augustine College u otra institución universitaria.
Certifico, bajo pena de perjurio, que lo antes
dicho es verdadero y correcto.
Applicant Signature:
Date: