Fillable Apts18-19 2018-2019 Aid for Part Time Study

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Apts18-19 2018-2019 Aid for Part Time Study

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A
id for Part-Time Study
(A.P.T.S.) Application
Academic Year - -
Submit this completed application to your school’s Financial Aid Office.
SCHOOL NAME
1. Social Security Number 2. Date of Birth (Use numbers only)
Month Day Year (CCYY)
3. Last Name First Name MI
4. Address: number, street, apartment
City or Town State Zip Code
Home Phone Number Work Phone Number
E-mail Address
5. Are you a legal resident of New York State? (See instructions on page 1.) Yes No
6. Check the box that applies to your citizenship status
.
Citizen Eligible Non-Citizen Not a Citizen or Eligible Non-Citizen
7. Marital status (Check only one box. See instructions on page 2.)
Unmarried (single, divorced or widowed) Married Separated
8. If married, enter the date you were married. If separated/divorced or widowed,
enter the earliest date on which you were separated/divorced or widowed.
Month Day Y
ear (CCYY)
9
. Have you graduated, or will you graduate from high school; or have you received or will you receive a high school equivalency diploma?
Yes No
10. Will all or part of your tuition charges be paid or reimbursed by an employer? Yes No
If yes, enter amount per semester. For Fall 2018 $____________ For Spring 2019 $______________
A
PPLICANT/SPOUSE (IF MARRIED) INCOME STATEMENT – (All applicants must answer Questions 11 and 12).
1
1. Enter number of dependent exemptions (item H) and net Taxable Income (line 37) from your 2016 form IT201.
Applicant's Separate NTI
OR Joint NTI with Spouse
Spouse's Separate NTI Only
Check the box if applicable:
Exemptions
Income
$
DOLLARS
CENTS
Income
$
DOLLARS
CENTS
I did not file a
NYS tax return for 2016
1
0
2
8
1
9
Hudson Valley Community College
12. Were you claimed or eligible to be claimed as a dependent on your parents’ New York State or federal tax returns for the previous year?
YES – If yes, YOU MUST REPORT PARENTS’ INCOME below.
NO – If no, read and sign the affirmation on the bottom of this page (#15). If you are married, your spouse must sign and enter their Social
Security number. If you have dependents of your own other than a spouse, check this box.
1
3. EXCLUSION OF PARENTS’ INCOME – If your parents are divorced, separated, never married or one of your parents is deceased, report in
question 14 the income of the parent with whom you lived most in the previous year or who had custody or would have had custody if you
were a minor.
TO EXLUDE THE INCOME OF YOUR FATHER (Stepfather, adoptive father) OR MOTHER (stepmother, adoptive mother) give the reason by checking
the appropriate box. Enter the date of death or separation/divorce and enter the amount of support received if separated/divorced. Only one
parents’ income can be excluded for separation/divorce.
To exclude FATHER’s Income FATHER deceased
Separated or divorced GIVE EARLIEST DATE
MONTH YEAR
Never married
To exclude MOTHERS’s Income MOTHER deceased
Separated or divorced GIVE EARLIEST DATE
MONTH YEAR
Never married
S
upport Amount – Enter the amount of support received for you from the parent whose income is to be excluded.
If none, enter zero.
$
DOLLARS
CENTS
(Note: any separation must be by judicial decree or pursuant to an agreement of separation which is filed by a court of competent jurisdiction.)
14. ENTER PARENTS EXEMPTIONS AND NET TAXABLE INCOME (NTI) IN THE BOXES PROVIDED FOR THE 2016 TAX YEAR.
Fathers' Separate NTI
OR Joint NTI with Mother
Mother's Separate NTI
Check the box if applicable:
Exemptions
Income
$
DOLLARS
CENTS
Income
$
DOLLARS
CENTS
I did not file a
NYS tax return for 2016
15. ALL PERSONS WHOSE INCOMES ARE LISTED IN QUESTIONS 11 AND 14 must read and sign the affirmation.
AFFIRMATION – I hereby certify that all the information provided by me upon this application is accurate and complete. This information will
be accepted for all purposes as the equivalent of an affidavit and, if it contains a false statement, shall subject me to the same penalties for
perjury as if I had been duly sworn. I authorize the school to release to Higher Education Services Corporation (HESC) any information requested
pertinent to this application. I consent to the verification by HESC of any statement made herein and authorize the NYS Department of Taxation
and Finance to release to HESC certified copies of my personal income tax returns. I consent to the release by HESC of such information as may
be provided by law or regulation in the course of financial aid program administration.
_________________________________
Student’s Signature Date
_________________________________ Spouse’s SSN First 3 Letters of Last Name
Student’s Spouses’ Signature Date
_________________________________ Father’s SSN First 3 Letters of Last Name
Father’s Signature Date
_________________________________ Mother’s SSN Last First 3 Letters of Last Name
Mother’s Signature
Date
If you answered “YES” to question 12, that is, you were claimed or were eligible to be claimed as a tax dependent, you must
report parental income in question 14. If your parents (stepparents, adoptive parents) filed a tax return as married, you must
report total income for both parents.
HVCC Financial Aid Office Phone 518-629-7150 Guenther Room 110
80 Vandenburgh Ave Fax 518-629-7479 Monday-Friday
Troy, NY 12180 financialaid@hvcc.edu 8AM-5PM
2018-2019 Aid for Part Time Study
Application Deadlines:
Fall 2018: September 7, 2018
Spring 2019: February 1, 2019
Read ALL Certification Statements below. Sign and date where indicated.
Read and complete the APTS Eligibility Requirements on the back of this page.
Complete the attached APTS Application. Provide all required signatures.
Submit signed
copies of your 2016 New York State Tax Return (Form IT201 or IT203). Dependent students must
also submit signed copies of their parents’ 2016 New York State Tax Return. If a New York State return was not
filed, submit a signed copy of the appropriate 2016 Federal Tax Return. All signatures are required and must be
provided in the appropriate space on page 4 of the tax return.
Return all of the above documents to the Financial Aid Office in Guenther 110.
CERTIFICATION STATEMENTS
I have read and understand the Aid for Part-Time Study Application, Instructions and Eligibility Requirements. By
signing this form, I am stating that, to my knowledge, I have completed the process and meet all of the eligibility
requirements.
I understand that awards will be determined and confirmed in writing. This confirmation will occur no earlier
than
the 10
th
week of classes each semester but could be later due to processing time.
I understand that if I owe a balance on my tuition, my APTS award will pay the amount due to Hudson Valley
Communi
ty College. If am due a refund, it will be issued to me within 45 day after I am notified in writing of my
award.
I understand that if I have applied for APTS for the Fall 2018 semester, m
y application will automatically be
reviewed for the Spring 2019 semester.
I understand that I may not receive more than one state grant in any given semester (i.e. TAP, Part-Time TAP
OR APTS). I confirm that this application for APTS authorizes Hudson Valley Community College to decertify any
other award I may qualify to receive.
I understand that the total amount of financial aid assistance (i.e.
grants, scholarships, student loans, tuition
assistance) I receive cannot exceed my Cost of Attendance (COA). I will consult with the Financial Aid Office
before accepting this award to ensure I fully understand the impact it may have on my financial aid package.
I understand that if I am awarded APTS it
will be factored in to my COA and that the Financial Aid Office may have
to adjust other forms of financial aid on my account to avoid over-awarding me.
If I choose to rescind my APTS application, I will notify the Financial Aid Office in writing before the end of the term.
Student Name
SSN
Student Signature
Date
2
2018-2019 AID FOR PART-TIME STUDY (APTS)
ELIGIBILITY REQUIREMENTS
I understand that in order to qualify for Aid for Part-Time Study, I must:
1. Have a valid and signed 2018-2019 Free Application for Federal Student Aid (FAFSA) on file with HVCC
by the APTS application deadline.
2. Be a legal resident of New York State, and a United States Citizen or eligible non-citizen.
3. If required, I must pass an approved Ability to Benefit (ATB) placement test prior to the end of the
add/drop period for the semester.
4. Be a matriculated student in an approved degree program.
5. Be registered in 6 to 11 degree applicable semester credit hours. If I am registered for at least 3 credit
hours, I may be considered for an award, if funding permits. I understand that priority is given to
students registered for at least 6 credit hours. I also understand that I do not qualify for APTS for
remedial, sprint or courses I am repeating.
6. Have achieved an overall cumulative Grade Point Average (GPA) of 2.00 or better.
7. Complete at least 50% of the minimum part-time load in each term of study for the first year, 75% in
the second year and 100% in the third and succeeding years for which an APTS award is received.
8. Meet the Good Academic Standing requirements as published in the Hudson Valley Community College
Catalog and website.
9. Have not exceeded the income limits, as listed on the “Instructions for Preparing an Application for Aid
for Part-Time Study” in this packet.
10. Not have exhausted my Tuition Assistance Program (TAP) eligibility.
11. Continue to participate in classes.
Student Name:
Phone Number:
Address:
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Apts18-19 2018-2019 Aid for Part Time Study

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Completed 5 November 2019

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