RETURN TO FINANCIAL AID OFFICE:
S
TUDENT
I
NFORMATION
2019-2020
ATB/Unit Eligibility Form
FSFA66
Last Name First Name M.I.
Student ID#
Please complete the following items to request verification of eligibility to take the Ability to Benefit
(ATB) test or verify completion of six (6) degree-applicable units to satisfy the Ability to Benefit (ATB)
unit requirement for federal financial aid eligibility.
YES, I am at least 18 years of age and no longer enrolled in high school.
If NO, STOP here. You are not eligible.
YES, I do not have a high school diploma, GED, or Certification of Proficiency.
If YES, continue below for further eligibility determination.
If NO, bring original HS Diploma, GED, or Certificate of Proficiency.
YES, I was enrolled in a college or university prior to July 1, 2012.
If YES, continue below for further eligibility determination.
If NO, STOP here. You are not eligible.
YES, I have submitted official transcripts from all colleges/universities outside of the Los Rios
District that I have attended to the SCC Admission and Records Office.
If YES, continue below for further eligibility determination.
If NO, submit the official records to the SCC Admission and Records Office before
submitting this form to the SCC Financial Aid Office.
Prior to July 1, 2012 I enrolled at the college/university: _________________________________________
CERTIFICATION AND SIGNATURE
I acknowledge that all information reported on this form and any attachment is true, complete, and accurate to the best
of my knowledge. I understand that if I receive Federal Student Aid based upon incorrect information, then I will need
to repay it; I may also be required to pay fines and fees.
Student: Date:
