Financial Aid Office
1355 West Highway 10, Anoka, MN 55303
Phone: 763.576.7730 Fax: 763.576.7721
2019-202
0 Minnesota State Grant Program Questionnaire
This application is to determine eligibility for Minnesota State Grants. Incomplete forms will delay processing. If additional
space is needed, please use the back of this form or include a separate piece of paper.
______________________________________________________ ______________________________________
Last Name First Name MI ATC Student ID
1. Please check one of the following:
Student graduated high school.
Name of High School: ____________________________ City/State/Country:______________________
Date Diploma Received: ____/_____ While Residing In: ___________________________
month / year state / country
Student received a G.E.D.
Date G.E.D Received: ____/_____ While Residing In: ___________________________
month / year state/country
2. I
f dependent student, did parents reside in Minnesota on date you completed 2019-2020 FAFSA? Yes No
If no, what is your parents’ state/country of residence? ____________________
3. I
f you are currently residing outside Minnesota, are you enrolling in all online courses? Yes No
4. P
lease list ALL the states (or countries) in which you have resided starting with your place of birth to the present
time. (Include Minnesota residence)
Name of State or Country
Reason for Residing in State
(e.g. college, employment,
Beginning Month/Year Ending Month/Year
plac
e of birth
5. Please list ALL the schools you attended after high school, location, and dates of attendance.
Name of School S
tate/Country of School Dates of Attendance Degree
*Im
portant Please Note: Please request your grade transcripts from the colleges above sent to the ATC Financial Ai
d
Office. An unofficial copy is acceptable for financial aid purposes. If you wish to have credits transferred to ATC, please
r
equest an official copy sent to ATC Records Office.
By
signing this questionnaire, you certify that all the information reported on it is complete and correct. If asked by a
school official, you agree to give proof of the information given on this form. If you do not provide proof when asked, you
may not receive aid.
____________________________________ ________________
Student Date
Rev 10/18 ATC is an affirmative action, equal opportunity educator/employer. To receive this information in an alternate format, 763-576-7730
