17MWARGR 11/17/2016
Student Name: __________________________________________ HCCID: __________________
To award the Iraq and Afghanistan Service Grant you may need to submit written
documentation verifying your eligibility.
1. Branch of Service: _____________________________________________________________
2. At time of death my parent or guardian served in: Iraq Afghanistan
3. Please check only one of the following options:
I was 23 years of age or younger when my parent or guardian died.
At the time of my parent or guardian’s death, I was age 24 or older and I had already enrolled
at the following institution of higher education:
Institution Name: ___________________________________________________________
At the time of my parent or guardian’s death, I was age 24 or older, and I had NOT enrolled at
any institution of higher education. I am ineligible for the Iraq and Afghanistan Service grant.
Student Signature: ___________________________________ Date: _______________________
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
We received notification from The U.S. Department of Defense that your parent/guardian died as
a result of military service in Afghanistan or Iraq after September 11, 2001. You may qualify for
additional federal aid if you meet additional eligibility requirements.
Additional Student Eligibility Requirements:
Be under 24 years old or
Enrolled in college at least part-time at the time of the parent’s or guardian’s death.
Please follow this link for more information: http://www.ifap.ed.gov/eannouncements/110609DODMatch.html
Iraq & Afghanistan Service Grant
Verification Form
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
