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CARES ACT REPORTING ON EMERGENCY FINANCIAL AID GRANTS TO STUDENTS
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Staff Introduction
Financial Aid Pre-Registration
Personal
Name
Address
City
State
Zip Code
Are you a U.S. Citizen?
Yes, I am a U.S. Citizen (U.S. National)
No, but I am an eligible noncitizen
No, I am not a citizen or eligible noncitizen
Birthdate
Age
Gender
Male
Female
Non-Specified
Race
African American/Black
American Indian/Alaskan Native
Asian
Hispanic/Latino
Native Hawaiian or Pacific Islander
White
Bi-racial
Unknown
How would you like us to contact you?
Phone
Email
N/A
Cell Phone
Email
Are you or were you in foster care, a ward of the court, an emancipated minor, in legal guardianship, or homeless?
Yes
No
Do you have children/dependents who live with you and receive more than half of their support from you?
Yes
No
Military Connection
No Military
Active Duty
Veteran
Spouse of Active Duty Military
Child of Active Duty Military
Are you married?
Yes
No
If you answered "NO" to all AND are younger than 24 years old, parental income, and signature are required
How many people are currently in your household (Including you)
Source of Income
Employment (Part Time)
Employment (Full Time)
None
Unemployment
Disability
TANF/SNAP (i.e. LINK)
Other
Household Income
$0 - $19,140
$19,141 - $25,860
$25,861 - $32,580
$32,581 - $39,300
$39,301 - $46,020
$46,021 - $52,740
$52,741 - $59,460
$59,461 - $66,180
Did your parent(s) complete a bachelor's degree?
Yes
No
What is your current education level?
No high school diploma / No GED
High school diploma
GED Program
Attending college/ no degree
Associated degree
Currently enrolled
I certify that all of the above information is true and correct to the best of my knowledge. Additionally, I consent to photo being used in promotional items.
Date
List all colleges/universities previously attended or currently attending. (List most recent first)
Is money owed to the school(s) listed above?
Yes
No
Are you in default?
Yes
No
What is your educational goal?
GED
Certificate (less than 30 Credits Hours)
Advanced Certification (30-49 Credits Hours)
Associate's Degree (average 60 credit hours)
Bachelor's Degree (average 120 credit hours)
Desired Start Term
Fall (August / September)
Spring (January)
Summer (May / June / July)
Challenges
How did you hear about us?
Social Media
Event
Friend / Family
In-Person
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