OFFICE OF FINANCIAL AID
4525 Education Park Drive, Schnecksville, PA 18078
P 610
.799.1133| F 610.799.1798
E finaid@mymail.lccc.edu
2020-2021 Parental Information Form
Student Name: ___________________________ Student ID:___________________________
Parent 1:
Last Name: _____________________________ First Initial: ____
Social Security Number: __________ - _____ - ______________
Date of Birth: _________________________
Parent 2:
Last Name: _____________________________ First Initial:____
Social Security Number: __________ - _____ - ______________
Date of Birth: _________________________
Marital 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): ________________________
Student Signature: ___________________________________ Date: ___________________
Parent 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
OFFICE USE: RRAAREQ Code - PARIN
WET SIGNATURE REQUIRED
WET SIGNATURE REQUIRED
