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Financial Aid Information Form - eSignature

STUDENT INFORMATION

Name:

Permanent Address:

Preferred Phone:

Alternate Phone:

Birth Date:

Student ID or Last Four Digits of SSN:

HIGH SCHOOL COMPLETION STATUS

Will you have a high school diploma, GED, or HSED prior to your enrollment at NCC?:

Diploma, GED, or HSED? (if applicable):

Date of Graduation (if applicable):

Date Received (if applicable):

From (if applicable):

NCC ENROLLMENT STATUS

NCC Program of Study:

Returning Student to NCC?:

Anticipated Graduation Date from NCC:

Anticipated Enrollment:

ENROLLMENT HISTORY

Attended Other Colleges?:

OUTSIDE SCHOLARSHIPS & OTHER FINANCIAL ASSISTANCE

Will you receive outside scholarships or other financial assistance?:

Scholarships (if applicable):

Other Financial Assistance (if applicable):

ACCEPTANCE OF FINANCIAL AID OVERVIEW

CERTIFICATION & SIGNATURE STATEMENTS

By signing below, I acknowledge that I have read and understand the Financial Aid Overview. Furthermore, I authorize NCC to apply all eligible financial aid funding to my tuition, fees, room and board, computer expenses, shop tickets, parking tickets, and prior year charges not to exceed $200.

By signing below, I authorize NCC to use my financial aid to purchase books, supplies, and other items that I charge at the College Store. I accept any and all charges made under this agreement. This authorization will remain in effect through the entire academic year. I must notify the Financial Aid Office in writing to discontinue this agreement.

By signing below, I authorize the Financial Aid Office to release my information and financial aid data to parties so they can determine my eligibility for funding (i.e. Workforce Innovation and Opportunity Act, Vocational Rehabilitation, Proteus, etc.).

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Timestamp

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September 11, 2017 8:30 pm CDT

Financial Aid Information Form - eSignature Uploaded by NCC Financial Aid - finaid@nwicc.edu IP 75.189.139.34