Revised 05/23/19
Achieving the Promise Academy
Tuition Assistance Request Fall 2019
Fall 2019 Deadline Monday, July 8, 2019
Students enrolled in ATPA can request tuition assistance 1) after completing one semester in ATPA in the most recent fall or spring term, 2)
satisfied all program requirements, and 3) received grades of C, B or A in each of their classes. If a course was dropped or a grade of W was
received, you must have been granted a refund on appeal. Tuition assistance awards are based on financial need and availability of funds. To
remain eligible for future tuition assistance from ATPA you must maintain the above mentioned requirements during the semester in which you
receive a tuition assistance award from the ATPA. You must be registered for your course(s) prior to submitting your tuition assistance request.
Incomplete forms will not be reviewed. Send this completed form to ATPA@montgomerycollege.edu.
APPLICANT INFORMATION – PRINT LEGIBLY AND COMPLETE ALL BOXES
Are you eligible for federal aid? Yes No
Are you eligible for Pell Grant: Yes No
Do you have an F1 Student Visa? Yes No
Date:
____/____/____
MM / DD / YY
Please check the boxes for which you are
requesting assistance:
Fall 2019 Tuition Assistance (deadline 07/08/19)
Fall 2019 Textbook Allowance (deadline 07/08/19)
For how many credits are you registered
for Fall 2019? ______Credit(s)
If requesting tuition assistance for courses, please list your courses below (ex: BIOL 101)
Are you a Nursing Student? Yes No
Nursing students are exempt from registering for courses prior to submitting this
tuition assistance request form.
In which semester did you enroll in ATPA (e.g., Fall 2016)? _____________________
How many semesters have you participated in ATPA (e.g., 3 semesters)? __________ Semester(s)
Have you previously received ATPA Tuition Assistance? Yes No If so, in which semester(s)? ________________________
Did you drop or withdraw from any course(s) this semester? Yes No If yes, did you receive a refund? Yes No
Did you receive a grade of D, F, or W last semester? Yes No
How many visits have you had with your coach this semester (e.g., 8 visits)? _______ Visits
How many Learning Community Hour (LCH) workshops have you attended this semester? ________ LCH Workshops
How many other workshops did you attend this semester (attendance verified in WCO)? ________ Other Workshops
Required: How will you be impacted if you do not receive this tuition assistance award?
Optional: Please explain any unusual circumstance affecting your financial need.
I certify that my answers are true and complete to the best of my knowledge.
My signature gives permission of the Montgomery College Achieving the Promise Academy to review any academic records and any information pertaining to my
eligibility for Federal Financial Aid.
ATPA@montgomerycollege.edu | 240-567-ATPA Form online: www.montgomerycollege.edu/ATPA
