Home Address______________________________________________________________________________________
Mailing Address if different
Type Yes or No__________
Type Yes or No__________
Type Yes or No__________ Grad Year__________
Type Yes or No__________
If you are attending another college or post-secondary school during the 2020-2021 academic year, please provide
the name of the school:
The Office of Financial Aid will release financial aid information to the following individuals, agencies and organizations. The student
must notify the office in writing if they do not wish for information to be released.
Applicant (and parents of dependent students)
Organizations sponsoring financial aid programs for which you may be eligible.
I certify that I do not owe a refund on any grant or loan, am not in default on any loan or have made satisfactory arrangements to
repay any defaulted loan, and have not borrowed in excess of the loan limits, under Title IV programs, at any institutions.
The Department of Education requires this calculation to be done for any financial aid recipient who does not successfully complete any
courses during a given semester. This applies to both official and unofficial withdrawals, failures, and incomplete grades. Any outstanding
balance that results from the retraction or adjustment of financial aid is the responsibility of the student.
Quincy College is authorized to make multiple loans under the same Master Promissory Note (MPN) for more than one academic year. If
you signed one MPN for all of your Direct Subsidized Loans and Direct Unsubsidized Loans, you must notify the College in writing if you
do not wish to borrow loans for a specific year. Loans will automatically disburse if you are enrolled in 6 or more credits and have assigned
an MPN to Quincy College within the last 10 years.
The Financial Aid Office reserves the right to amend or cancel any award within Federal, State, and College guidelines. Quincy College is not
responsible for notifying students of exceeding the maximum aggregate Federal Direct Stafford Loan limits or Pell Life Eligibility percentage
used. Students can view revised awards on their QC portal at www.quincycollege.edu. It is the student’s responsibility to consistently review
awards and account activity each semester to be aware of any changes. Any resulting balance is the student’s responsibility.
I will use the Title IV money only for expenses related to my study at Quincy College.
Warning: To receive any Title IV financial aid, you must validate the certification statement on refunds
and default, and the stalemate of education purpose with your signature. You must be registered with
the Selective Service if you are required to register. If you purposely give false or misleading
information, you may be subject to up to a $1 0,000 fine, imprisonment for up to 5 years, or both.
I certify that all the information I have entered on this form is correct and complete. I understand that I am responsible for all
charges not covered by my financial aid.
Student Signature
Date _
Parent Signature
(Parent signature is required for Dependent students only)
IMPORTANT: The Free Application for Federal Student Aid (FAFSA) must be completed in addition to
this form in order to determine financial eligibility.
In accordance with federal civil rights law, Quincy College does not discriminate in its educational programs and activities on the basis of race, color, national
origin, ancestry, sex, gender, gender identity, gender expression, sexual orientation, physical and/or mental disability, age, religion, medical condition, veteran
status, marital status, genetic information, or any other characteristic protected by institutional policy or state, local, or federal law. The requirement of non-
discrimination in educational programs and activities extends to employment and admission. The following persons have been designated to handle inquiries
regarding the non-discrimination policies, including Title IX and Section 504, relative to student matters is Susan Bossa, AVP for Student
Development, sbossa@quincycollege.edu and Title IX, Section 504, and Title VI relative to employee related matters is Christopher Bell, Assistant to the
President, cbell@quincycollege.edu.