New Student Financial Aid Information Form

STUDENT SERVICES DEPARTMENT

New Student Financial Aid Information Form - Undergraduate Student

Section A: General Information

Demographic Information

Last 4 Digits of SSN: *

Date of Birth * +

Are you 18 years of age or older? *

No

Yes

Legal Last Name *

Legal First Name *

Middle Initial

Mailing Address *

Address Line 2

City *

State *

Zip Code *

Cell Number *

Home/Other Number

Email Address *

Enrollment Information

Campus *

Stockton

Modesto

Online

When do you plan on attending? *

Summer

Fall

Winter

Spring

What is your anticipated enrollment status? *

Full time (12 or more units)

Half time (6-8 units)

Less than half time (5 units or less)

Year *

Who is your Admission Counselor? *

What is your declared degree/major? *

Are you expecting veteran’s educational benefits? *

No

Yes

Chapter: *

Are you a current Humphreys University employee who is eligible for the Humphreys University Tuition Waiver? *

No

Yes

Provide an explanation: *

Are you a current full-time employee of ABLE Charter High School or ABLE Charter Elementary? *

No

Yes

Beginning Date of Employment: *

Are you a parent or legal guardian of a child currently attending ABLE Charter High School or ABLE Charter Elementary? *

No

Yes

Child 1 Name: *

Child 2 Name:

What is your high school completion status? *

Year *

Month *

Name of the High School & Country *

Please Explain: *

Academic History

Previous Colleges or Universities Attended:
(Beginning with the most recent, list all colleges/universities and technical/vocational schools previously attended.)

	University/College	Year Attended
1.	University/College	Year Attended
2.	University/College	Year Attended
3.	University/College	Year Attended

Do you have an Associate Degree? *

No

Yes

Major/Degree: *

Do you have a Bachelor's Degree? *

No

Yes

Major/Degree: *

Do you have a professional/Masters/Doctorate degree?

*

No

Yes

Major/Degree: *

Will you be transferring units/credits? *

No

Yes

High School Diploma	Passed HSET State Test	Passed TASC State Test	Passed CHSPE State Test	Foreign High School
GED	Other