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3041 West Avenue K, Lancaster, California 93536 Phone: (661) 722-6300 Ext.6337
EMERGENCY FINANCIAL ASSISTANCE
SELF-CERTIFICATION FORM
Emergency Financial Assistance to Low-Income Community College Students.
Student Eligibility Criteria:
Grants may be awarded to students who are California residents or are exempt from paying nonresident
tuition under §68130.5 of the California Education Code who self-certify that they meet the following
conditions:
• Currently enrolled in 6-degree applicable units. This includes newly enrolled students.
• Demonstrate an emergency financial aid need.
• Qualify as low-income by meeting the requirements to receive a California College Promise
Grant (CCPG) or is projected to receive a CCPG for the upcoming term.
• Earned a 2.0 grade point average at their current or prior institution in one of the previous three
semester terms (or four quarter terms) OR is a student who is receiving additional support or
services through a community college’s Disabled Student Programs and Services
Please complete the below self-certification form, attach supporting documentation and submit this
form to the financial aid office.
Student Name: ______________________________________ Student ID: ___________________
Telephone #:____________________________________
1.
Are you currently enrolled in 6-degree applicable units?
Yes No
2.
Have you earned a 2.0 grade point average at your current or prior institution in one of the previous
three semester terms? Yes No
2a. If no, select all that apply:
You receive additional support or services through the Disabled Student Programs
and Services.
You are a first-time student.
You have taken only Pass/No Pass or non-credit courses.
COVID-19 related issues.
Other: ______________________________________________________
3.
Have you been awarded a California College Promise Grant (fee waiver) for the 2020-21 or 2021-22
academic year? Yes No
