20/21 ( )
FA INCOME
FAX: (719)502-2074 EMAIL: FINANCIALAID@PPCC.EDU
ASSET Student Application for Colorado State Aid
S _________________________ Student ID number
Printed Name: ____________________________________________Phone Number: ________________
Pursuant to Colorado HB 19-1196, which allows students who qualify for in-state tuition per CRS 23-7-110 to
receive state-funded financial aid, PPCC can award state financial aid to ASSET students. Eligibility can be
determined by providing documentation showing proof of one of the criteria below. Please mark which
criteria you (or your family) qualify for and attach proof/documentation to this form.
IMPORTANT: You must also complete and submit the application for the Colorado Opportunity Fund (COF)
including the Affidavit on the second page of that form. Apply for COF at https://cof.college-assist.org/.
Completed 2020-2021 FAFSA showing a Pell-eligible EFC (complete your FAFSA at www.fafsa.gov)
OR
Documentation that you qualify to receive ONE of the following benefits:
Temporary Assistance to Needy Families (TANF) Benefits
Supplemental Nutrition Assistance Program (SNAP) Benefits
Medicaid
Supplemental Security Income (SSI) or Disability Benefits
Section 8 Housing
Women, Infants, and Children (WIC) Benefits
OR
Your most recent federal tax return showing that your income is eligible for Free and Reduced-Price
Lunch Benefits.
OR
Documentation that your income is below the tax-filing requirement threshold.
I certify that I qualify as a Colorado ASSET student and will attach proof/documentation of my eligibility for
one of the income criteria marked above. By signing this document, I certify that the information is complete,
true and accurate. I understand that purposely providing false or misleading information could result in
criminal prosecution, prison sentence, and/or a fine pursuant to U.S. Criminal Code and Colorado Criminal
Code.
Student signature: _____________________________________________ Date: _________________
