DIVISION OF STUDENT AFFAIRS
Office of Financial Aid & Scholarships
“The Higher Education Institution of the Navajos”
2016-2017 FINANCIAL AID DATA FORM
(July 1, 2016 to June 30, 2017)
ACADEMIC TERM INFORMATION
Enrollment Status:
Campus/Site you will be attending:
Please Check Term(s) Applying For:
☐ Fall 2016
☐ Spring 2017
☐
☐
☐
☐
☐ Summer 2017
Admission Status:
☐ New Student ☐ Returning ☐ Transfer ☐ DC Graduate
Fulltime (12)
¾ Time (9-11)
Half time (6-8)
Less than half (1-5)
☐ Chinle
☐ Crownpoint
☐ Window Rock
☐ Tuba City
☐ Shiprock
☐ Tsaile (Main Campus)
☐ Online
INSTRUCTIONS: To complete this form, please print clearly using a Blue/Black pen, Diné College requires that all students
complete the 2016-2017 FAFSA, to be considered for Pell Grant, other Federal, State and Tribal Grants/Scholarships.
STUDENT PERSONAL INFORMATION
Last Name
First Name
Middle Initial
Social Security #
*ID#
REQUIRED
Mailing Address (P.O Box, Street Address, etc.)
Current Home Telephone Number
Date of Birth
City
State
Cell Phone Number
Gender
☐ Male
Email Address
Marital Status
☐ Single ☐ Married
☐ Female
Zip Code
☐ Separated
If Native American,
Tribe: ___________________________________________
☐ Widowed/Divorce
☐ Common Law
Chapter:_____________________________________
ACADEMIC INFORMATION
Date of Graduation
☐ H/S Diploma
Name of High School
DC Current Major
☐ GED
REQUIRED
Type of Degree(s) you are currently seeking:
☐ (CT) Certificate
☐ (AS) Associate of Science
☐ (BA) Bachelor of Arts
☐ (AA) Associate of Arts
☐ (AAS) Associate of Applied Science
Please Check Type of Degree(s) you have ALREADY received and/or earned
☐ None
☐ Certificate
☐ Associate’s
☐ Bachelor’s
☐ Master’s
☐ Ph.D.
RETURNING STUDENTS: Have you ever received Financial Aid at Diné College?
☐ Yes
☐ No
If so, which semester and year you last attended at Diné College? __________________________________________
Name of Last College/University Attended
Attendance Date (Month & Year)
Did You Receive Financial Aid?
☐ Yes
☐ No
Name of Last College/University Attended
Attendance Date (Month & Year)
Did You Receive Financial Aid?
☐ Yes
☐ No
Student’s # of Child(ren):
#
FAMILY INFORMATION (All applicants must complete this section)
Ages:
☐ Yes
☐ No
BACKGROUND INFORMATION (Must be completed)
Are you a first generation student (the first person in your immediate family to pursue a college degree)?
☐ Yes
☐ No
Are you a caretaker for an elderly parent or grandparent in your home?
☐ Yes
☐ No
Were you employed less than 20 hour per week in 2015 (excluding work study)?
☐ Yes
☐ No
Were you employed 20 or more hours/week in 2015 (excluding work study)?
☐ Yes
☐ No
Did you attend a “Head Start program” as a child?
CERTIFICATION AND SIGNATURE
Please read, sign, and date. By signing this form, I certify that all information provided is accurate and I have not purposely given false or misleading information.
I certify that I will use all Title IV, Tribal, State funds received only for expenses related to my studies at Diné College. During review and verification of my
FAFSA/ISIR and correction(s) is required; I give permission to the Financial Aid staff to make any necessary corrections on my FAFSA.
Student Signature
1617
Date
REQUIRED
FADF
Rv:2/02/16