Please complete this application and attach it to your written statement,
recommendation and transcripts. To insure proper consideration of application, hand
all information in together to the Financial Aid Office at LCCC, no later than May 1.
Name
Social Security Number
Phone Number Cell Phone Number
Address
Street
City, State, ZIP
Income
Actual prior year income or
current year to date
Estimated Income for
remainder or current year
Income earned from work by student
(wages, salaries, tips, etc)
Income earned from work by spouse or
parent(s) (wages, salaries, tips, etc)
Other benets paid on your behalf
Child support received
Other untaxed income (VA, Military
income, workers comp, pension
Scholarships received or
applied for – current year
Please check appropriate lines circles: Married
Divorced
Single
Number in the family:______________ Number in college:______________
By checking this box, I hereby certify the provided information is accurate to the
best of my knowledge. I also certify that I will allow the Scholarship and Financial
Aid Office at LCCC to release any information that is applicable to this application.
_____________________
Date
