OFFICE OF FINANCIAL AID
4525 Education Park Drive, Schnecksville, PA 18078
P 610.799.1133| F 610.799.1798
E finaid@mymail.lccc.edu
OFFICE USE: RRAAREQ Code - PARIN
2019-20 Parental Information Form
S
tudent Name: ___________________________ Student ID:___________________________
P
arent 1:
Last Name: _____________________________ First Initial: ____
Social Security Number: __________ - _____ - ______________
Date of Birth: _________________________
P
arent 2:
Last Name: _____________________________ First Initial:____
Social Security Number: __________ - _____ - ______________
Date of Birth: _________________________
Ma
rital Status:
_____ Never Married ______ Unmarried and both parents living together
_____ Married/Re-married ______ Divorced/Separated
_____ Widowed
Date of Status: ____________________________
Legal
Residence:
State of Legal Residence: ___________________ Since (Date): ________________________
S
tudent Signature: ___________________________________ Date: ___________________
P
arent Signature: ____________________________________ Date: ___________________
Please return this form within 15 days of receipt
of this request to:
Lehigh Carbon Community College
4525 Education Park Drive
Schnecksville, PA 18078
