Fillable ALABAMA STUDENT GRANT PROGRAM GENERAL INFORMATION The Alabama (Samford University)

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ALABAMA STUDENT GRANT PROGRAM GENERAL INFORMATION The Alabama (Samford University)

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ALABAMA STUDENT GRANT PROGRAM
GENERAL INFORMATION
The Alabama Student Grant Program is a state student assistance program established August 4, 1978 by the Legislature of
the State of Alabama and designed to provide financial assistance to residents of the State of Alabama for undergraduate
nonsectarian, secular education at independent, nonprofit, or other legislatively identified postsecondary educational
institutions of higher learning located within the State of Alabama.
STUDENT ELIGIBILITY REQUIREMENTS
To be eligible for an Alabama Student Grant Program award the student must:
(1) Have obtained a certificate of graduation from a secondary school or the recognized equivalence of such graduation;
(2) Be classified as an undergraduate student;
(3) Be an Alabama resident as defined in Alabama Student Grant Program Act 90;
(4) Be a citizen of the United States or in the process of becoming a citizen of the United States;
(5) Be enrolled as a full-time or half-time student in an eligible program in an approved institution;
(6) Be making satisfactory academic progress; and,
(7) Not be enrolled and not intend to enroll in a course of study leading to an undergraduate degree in theology, divinity,
or other field of preparation for a religious vocation.
USE OF SOCIAL SECURITY NUMBER
SECTION 7 (b) of the Privacy Act of 1974 (5 U.S.C. 522a) requires that when any Federal, State, or local government
agency requests an individual to disclose his/her social security account number, that individual must also be advised
whether that disclosure is mandatory or voluntary, by what statutory or other authority the number is solicited, and what uses
will be made of it.
Accordingly, applicants are advised that disclosure of their social security account number (SSAN) is required as a condition
for participation in the Alabama Student Grant Program, in view of the practical administrative difficulties which the Program
would encounter in maintaining adequate program records without the continued use of the SSAN.
The SSAN will be used to verify the identity of the applicant and as an account number (identifier) throughout the life of the
grant in order to record necessary data accurately. As an identifier, the SSAN is used in such Program activities as:
determining Program eligibility, certifying school attendance, making and verifying grant payments, and maintaining records
of grant payments.
Authority for requiring the disclosure of an applicant’s SSAN is in section 7 (a) (2) of the Privacy Act, which provides that an
agency may require disclosure of an individual’s SSAN as a condition for the granting of a right, benefit, or privilege provided
by law.
THIS APPLICATION MUST BE COMPLETED AND RECEIVED BY THE INSTITUTION’S STUDENT FINANCIAL AID
OFFICE ON OR BEFORE THE DEADLINE OF SEPTEMBER 16, 2019 IN ORDER TO RECEIVE CONSIDERATION
FOR FALL TERM 2019. THE FOLLOWING DATES ARE APPLICATION DEADLINES FOR OTHER TERMS: WINTER
QUARTER ― JANUARY 15, SPRING SEMESTER ― FEBRUARY 17, AND SPRING QUARTER ― APRIL 15, 2020.
W A R N I N G
ANY PERSON WHO KNOWINGLY MAKES A FALSE STATEMENT OR A MISREPRESENTATION FOR THE PURPOSE
OF WRONGFULLY OBTAINING A GRANT HEREUNDER SHALL BE GUILTY OF A MISDEMEANOR AND, UPON
CONVICTION THEREOF, BE PUNISHED AS BY LAW PROVIDED FOR A MISDEMEANOR.
NOTE: TWO (2) PROOFS OF ALABAMA RESIDENCY ARE REQUIRED
ALABAMA STUDENT GRANT PROGRAM 2019-2020 STUDENT APPLICATION
1. Social Security Number 2. Name
3. Birth Date 4. Business Phone 5. Home Phone
6. Mailing Address
7. College or University attending or planning to attend in 2019-2020
8. Field of Study for 2019-2020 9. Student Number (if known)
10. Are you enrolled or accepted for enrollment as at least a half-time student in a program of at least 6 months duration? Yes No
11. Will you be enrolled in a course of study leading to a degree in theology, divinity, or other field of preparation for a religious vocation? Yes No
12. Are you a high school graduate, or have you obtained the recognized equivalence? Yes No
13. Are you a citizen of the U.S. or in the process of becoming a citizen of the U.S.? Yes No
14. Have you been a resident of the State of Alabama for the last 12 months? Yes No
15. Have you previously received a bachelor’s degree or its equivalence? Yes No
SECTION I:
This Section must be completed by first-time applicants. Provide two (2) of the five (5) proof requirements listed below of residency.
1.
Residence – Student
I hereby affirm that I have had my habitation and permanent residence in the State of Alabama for the twelve (12) months immediately preceding the
date of this application.
Address
Number and Street
City State Zip Code
2.
Voter Registration – Student
I hereby certify that I am a registered voter in
County State
3.
Residence – Parent
I hereby certify that this address is my legal residence:
Number and Street
City State Zip Code
Parent’s or Guardian’s Signature
4.
Voter Registration – Parent
I hereby certify that I am a registered voter in
County State
Parent’s or Guardian’s Signature
5.
Driver’s License: Attached is a photocopy of the student’s or parent’s valid Alabama driver’s license. Yes No
SECTION II:
I have read and understand the student eligibility requirements of this grant from the Alabama Student Grant Program. I certify that I am
eligible under the conditions stated and affirm that the proceeds of this grant, as authorized by Act 90 of the Second Special Session of the
Alabama Legislature 1978, will be used solely for nonsectarian, secular educational expenses related to attendance at an independent,
nonprofit, or other legislatively identified postsecondary educational institution in Alabama.
.
I CERTIFY THAT THE INFORMATOIN CONTAINED IN THIS APPLICATION, INCLUDING ATTACHMENTS, IS CURRENT AND COMPLETE. I
AGREE THAT THE INSTITUTION AND THE ALABAMA COMMISSION ON HIGHER EDUCATION HAVE MY PERMISSION TO VERIFY IT.
Signature of Student Date
INSTITUTIONAL DATE STAMP
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ALABAMA STUDENT GRANT PROGRAM GENERAL INFORMATION The Alabama (Samford University)

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Completed 26 August 2020

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