I have ﬁled a 1920 FASFA:
Yes ☐ No
I have completed all requests for veriﬁcation from the Financial Aid Oﬃce:
Have you received
any of the following between 2017-2018? Check all that apply:
SSI – Supplemental Assistance Income
SNAP – Special Nutrition Assistance
Program Free or Reduced Lunc
TANF – Temporary Assistance for Needy Famil
8 Subsidy Family/friend’s assistance
Income Spouse income
axed Income Unemployment Compensation
upport Received Alimon
Will you be receiving GSRP, DHH
S Cash Assistance, or Head start funding? Yes
No - If Yes, provide documentation
Are you an International Student? Yes No
If you checked “Yes”
you do not need to ﬁle a FAFSA. Pleas
e provide copies if your income, spouse’s income (if married),
parents income (if you are a dependent student), and any other forms of ﬁnancial assistance you may receive.
Please sign below to verify that you agree to the conditions and responsibilities of this award and that you assume responsibility for
nsing Community College policies.
1. If I drop a course, my grant will be decreased accordingly.
2. The check will be sent directly to the child care provider.
3. I will onl
y receive assistance for approved classes taken on a credit basis, not classes taken on an audit basis.
4. I underst
and my academic progress will be monitored, and funding decisions will be made by committee on a case by case basis.
5. I understand that the child care assistance funds are limited and may not be available in subsequent semesters.
6. I will rep
ort any changes in income, marital status, number of dependents, and/or change in child care to the ARC.
7. I give pe
rmission to the Adult Resource Center (ARC) at Lansing Community College to have access to my enrollment, Financial Aid,
skill level scores, academic progress, and
8. I do here
by give permission to the staff of the ARC to release information pertaining to my child care grant, enrollment, and class
e to my licensed child care provider, and to the DHS.
9. Applications without documentation will not be able considered for the grant.
mmunity College is an equal opportunity educational institution/employer. Lansing Community College programs and
re open for all
persons regardless of race, color, sex, age, religion, national origin, creed, ancestry, height, weight,
sexual orientation, gender identity, gender expression, disability, familial status, marital status, military status, veteran’s status, or
status as p
rotected by law, or genetic information.
I certify t
hat I am the custodial parent of the
children listed on
this application and can provide
proof of custody if requested by the Adult Resource
Center and/or th
e Financial Aid Oﬃce.
I certify that all statements made on this application are true to
the best of my knowledge and I can provide proof of
information stated on this application if requested by the Adult
Resource Center and/or the Financial Aid Oﬃce.
Drop off application to:
LANSING COMMUNITY COLLEGE
Starzone Center for Student Support
Mail application to:
ARC - 1130
Lansing Community College
P.O. Box 40010
Lansing, MI 48901-7210
For more information: