*DEMO*
1617
*TRACKING REQUIREMENT*
2016-2017 SUPPLEMENTAL INFORMATION & CERTIFICATION FORM
Last Name: _____________________ First Name: __________________ MI: ___
Previously Used Name: _____________________________  Male
 Female
ID#: W____________________
Social Security #:
_____ - ____ - ______
Street: __________________________________________City: ________________________State/Zip: ____________
Home Phone: (______) ____________________________ Cell Phone: (_____) __________ ____________________________
Verify address & phone in Class Web, and update changes with Admissions and Records; we cannot change for you. The Financial Aid Office
sends e-mail notifications to all Chabot financial aid applicants via their ZoneMail account. We recommend you forward your ZoneMail to your
personal email account to ensure you receive all communication in a timely manner; instructions are available on the Zone.
 Yes
Do you have a high school diploma or its equivalent?
(Foreign School, GED, High School Proficiency)
Year ___________* High School _______________________________________________________
 No
(NOTE: If no to above, and are enrolling in program of study after 7/1/12, you are ineligible for Federal or State financial aid. If you
enrolled prior to 7/1/12, you may be eligible by passing an Ability to Benefit (ATB) test or successfully completing at least six units of academic
coursework.)
**A student must be admitted to Chabot College (not LPC), and must be enrolled in an eligible Chabot Certificate, Associate or Transfer
degree/major to qualify for Federal or State financial aid. Each semester as you register for classes, you must ensure that you correctly identify your
primary major and educational goal (i.e. Certificate, Associate or Transfer program) with Admissions & Records. There will be no financial aid
disbursements for ineligible or undeclared majors/programs.
Do you (or will you) have a Bachelor’s degree from any college or university in the U.S. or from another country by the time you
would receive financial aid from Chabot?
 Yes  No
After which term do you expect to graduate/transfer from Chabot College?
Fall / Spring / Summer 20______
Will you be enrolled at another institution between July 1, 2016 and June 30, 2017?
 Yes
 No
If yes, name of school? _________________________ Which term(s)? _______________________
Have you received (or will you receive) Federal/State funds from another school for the 2016 -2017 year?  Yes  No
If yes, from which school? _________________________ Which term(s)? __________________
(You may only receive Financial Aid from one institution each term.)
1)
Students are now limited to a lifetime maximum of six years / 12 semesters of full time Pell Grant (600%), regardless of completion
of academic program or Bachelors Degree. Log onto www.nslds.ed.gov to calculate your current aggregate lifetime amount received.
There are no exceptions nor appeals allowed by the Dept of Education. Any Pell Grant received over the 600% is the student’s
responsibility and must be repaid.
2)
Federal Financial Aid regulations require that at minimum Chabot include units earned at other colleges or universities that apply toward your
current program of study at Chabot when calculating your financial aid eligibility. Specifically, we must determine if you meet minimum Satisfactory
Academic Progress standard of ability to successfully complete your program of study within the allowed time limit (measured in attempted units)
Official transcripts submitted to the Chabot Admissions & Records Office will be evaluated for units that may apply to a Chabot program of study.
Some students will be required to provide all official transcripts to be considered for aid, per federal requirements.
All Chabot students must have a modified SEP (Student Educational Plan) by the time they have 30 attempted units at Chabot-LPC to be considered for
financial aid. Students are required to make an appointment with an Academic Counselor to complete a modified SEP well before the start of the
semester as Counselor schedules fill up quickly. If you have prior academic units to be applied to your degree objective at Chabot, you must have
official transcripts on file with Chabot Admissions & Records Office so Counselors can include in your SEP. New students should attend a New
Student Orientation through Counseling, only available through the beginning of each term. (See class schedule for dates and times.)
No financial aid disbursement will occur until SEP and required prior academic transcript requirements are met.
3)
4)
I certify that 1) I have read this entire form, understand the information it contains and agree to comply with all instructions, and 2) the
information I have provided here is true, complete and accurate to the best of my knowledge. I authorize Chabot College to deduct any outstanding
fees or other charges owed by me to Chabot-Las Positas College District from any financial aid I am entitled to receive, including charges from prior
academic years. I am aware that this authorization is voluntary and I may rescind it in writing. Any outstanding debts made prior to rescinding my
authorization are subject to withholding.
Warning: If you purposely give false or misleading information on this application, you may be fined up to $20,000, sentenced to
jail, or both. You will be required to repay any and all aid that you receive as a result of false information provided, and will be
referred for violation of student code of conduct for possible disciplinary action.
Student Signature ___________________________________
Date ___________
Revised 02/11/16