Return this completed form to: 104 Fairchild Hall | 1601 Vattier Street Office 785-532-6420 | Fax 785-532-7628
Manhattan, KS 66506-1104 Website ksu.edu/sfa
| Email finaid@ksu.edu
Student Information
Student’s Name (Last, First, MI) Wildcat Identification Number
Student’s Street Address Student’s Date of Birth
City State Zip Code Student’s Email Address
Please mark your status as a degree-seeking student:
I am enrolled as a full-time undergraduate student.
I am enrolled as a graduate student.
I am enrolled as a veterinary medicine student.
I am enrolled less than full-time as an undergraduate student.
(Applicable to spouses only)
I request that this grant be awarded for:
Fall 2019 / S
pring 2020
Fall 2019 only Spring 2020 only
Signature of Student (required) Date
Digital signatures are not accepted.
K-State Employee Information
Student listed above is a dependent child of mine. Student listed above is my spouse. Deceased Employee
“Dependent” refers to a natural, step, adopted,
or foster child under the age of 25, who is unmarried.
By signing below:
1. I confirm that I have read and understand the eligibility criteria found at k-state.edu/sfa/aid/etb/dsg.html
2. I expect to carry a full time (0.9 FTE or above), benefits eligible, regular appointment with Kansas State University
throughout the 2019 - 20
20 academic year.
3. I understand that misrepresentation of any information provided on this application may result in a penalty including, but not
limited to, repayment of any K-State Dependent/Spouse Grant(s) received.
Printed Name of K-State Employee (Last, First, MI) K-State Employee Identification Number
Signature of K-State Employee (required) Date
Digital signatures are not accepted.
Department Certification
By signing below, I certify that the above listed K-State employee is currently employed with Kansas State University and I
anticipate, at this time, that he or she will be employed in a
full-time (0.9 FTE or above), benefits eligible, regular appointment
and is expected to remain employed throughout the academic semester(s) indicated above.
Department Name
Signature of Department Head (required) Printed Name of Department Head (required) Date
Digital signatures are not accepted.
2019 - 2020
Dependent / Spouse
Grant Application
