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The Financial Aid Office will review your income and let you know if you qualify for a CALIFORNIA COLLEGE PROMISE GRANT under Method B. Submit
application and documentation to the financial aid office.
If you do not qualify using Method A or Method B, or if you want to be considered for other financial aid, you should file a FAFSA (for U.S. citizens or eligible non-
citizens) or the California Dream Application (for undocumented AB 540 students). The FAFSA is available at www.fafsa.gov and the Dream Application is available
at https://dream.csac.ca.gov/. Contact the Financial Aid Office for more information.
SPECIAL CLASSIFICATIONS ENROLLMENT Fee Waivers
18. Do you have certification from the CA Department of Veterans Affairs that you are eligible for a dependent's fee waiver?
Submit certification. Yes No
19. Do you have certification from the National Guard Adjutant General that you are eligible for a dependent's fee waiver?
Submit certification. Yes No
20. Are you eligible as a recipient of the Congressional Medal of Honor or as a child of a recipient?
Submit documentation from the Department ofVeterans Affairs. Yes No
21. Are you eligible as a dependent of a victim of the September 11, 2001, terrorist attack?
Submit documentation from the CA Victim Compensation and GovernmentClaims Board. Yes No
22. Are you eligible as a dependent of a deceased law enforcement/fire suppression personnel killed in the line of duty?
Submit documentation from the public agency employer of record. Yes No
• If you answered "Yes" to any of the questions from 18-22, you are eligible for a CALIFORNIA COLLEGE PROMISE GRANT and perhaps
other aid or adjustments. Sign the Certification below. Submit application and documentation to the financial aid office. Contact the
Financial Aid Office if you have questions.
CERTIFICATION FOR ALL APPLICANTS: READ THIS STATEMENT AND SIGN BELOW
I hereby swear or affirm, under penalty of perjury, that all information on this form is true and complete to the best of my knowledge. If asked by an
authorized official, I agree to provide proof of this information, which may include a copy of my and my spouse/registered domestic partner
and/or my parent's/registered domestic partner’s 2017 U.S. Income Tax Return(s). I also realize that any false statement or failure to give proof
when asked may be cause for the denial, reduction, withdrawal, and/or repayment of my waiver. I authorize release of information regarding this
application between the college, the college district, and the Chancellor's Office of the California Community Colleges.
I understand the following information (please check each box):
Federal and state financial aid programs are available to help with college costs (including enrollment fees, books & supplies,
transportation and room and board expenses). By completing the FAFSA or the California Dream Application, additional financial
assistance may be available in the form of Cal Grants, Federal Pell Grant and other grants, Federal Work Study and other aid.
I may apply for and receive financial assistance if I am enrolled, either full time or part time, in an eligible program of study
(certificate, associate degree or transfer).
Financial aid program information and application assistance is available in the college financial aid office.
Applicant’s Signature Date Parent Signature (Dependent Students Only) Date
CALIFORNIA INFORMATION PRIVACY ACT
State and federal laws protect an individual’s right to privacy regarding information pertaining to oneself. The California Information Practices Act of 1977 requires the following information be
provided to financial aid applicants who are asked to supply information about themselves. The principal purpose for requesting information on this form is to determine your eligibility for
financial aid. The Chancellor’s Office policy and the policy of the community college to which you are applying for aid authorize maintenance of this information. Failure to provide such
information will delay and may even prevent your receipt of financial assistance. This form’s information may be transmitted to other state agencies and the federal government if required by law.
Individuals have the right of access to records established from information furnished on this form as it pertains to them.
The officials responsible for maintaining the information contained on this form are the financial aid administrators at the institutions to which you are applying for financial aid. The SSN may be
used to verify your identity under record keeping systems established prior to January 1, 1975. If your college requires you to provide an SSN and you have questions, you should ask the financial
aid officer at your college for further information. The Chancellor’s Office and the California community colleges, in compliance with federal and state laws, do not discriminate on the basis of
race, religion, color, national origin, gender, age, disability, medical condition, sexual orientation, domestic partnership or any other legally protected basis. Inquiries regarding these policies may
be directed to the financial aid office of the college to which you are applying.
FOR OFFICE USE ONLY
CCPG-A CCPG-B Special Classification Student is not eligible Student RDP Parent RDP
TANF/CalWORKs Veteran National Guard Dependent
GA CCPG-C 9/11 Dependent Medal of Honor Homeless
SSI/SSP Dep. of deceased law enforcement/fire personnel
Comments:
Certified by: _____________________________________________________________ Date: _______________________________________
05/15/2019
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/GlendaleCollege /GCCPIO /GlendaleCollege /GlendaleCollege
