HIGHLAND COMMUNITY COLLEGE
FINANCIAL AID DATA FORM
2015-2016
PERSONAL INFORMATION
Name: ____________________________________ Social Security Number________________
List any other surnames (last names) used previously: ________________________________
Address: ______________________________________________
Apt. #: ______________
City: ________________________________ State: ____________ Zip: __________________
Home Phone: _______/_______________ Date of Birth: _____/_____/19____
Male: ____
Female: ____
Circle your current status: SINGLE
MARRIED
DIVORCED
SEPARATED
WIDOW(ED)
Do you receive Social Security Benefits? Y__ N__ If Yes --- - enter the monthly benefits $_________
If you are under 24 years old enter your parent’s information in this section:
Parent’s name:___________________________________________________________________________
Parent’s phone number:______/_____________________________________________________________
Parent’s address if different from yours listed above: _____________________________________________
Do your Parent’s receive Social Security Benefits? Y__ N__ If Yes --- - enter the monthly benefits $_________
ACADEMIC INFORMATION
Have you been an Illinois resident since before August 1, 2014? Y___ N____
Have you completed High School or earned your GED? Y___ N___
What year did you or will you earn this? ___________
What high school or GED organization: _____________________________
City/State__________________________
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