The Adult Resource Center
Special Populations Grant Application
Summer 2020
Drop off application to:
Gannon Building:
Starzone Center for Student Support
Mail application to:
ARC - 1130
Lansing Community College
P.O. Box 40010
Lansing, MI 48901-7210
For more information:
Call 517-483-1199
The Special Populations Grant is a resource that can help students pay for attendance costs.
You must be pursuing or will pursue an occupational program to qualify.
I have submitted the 2019-2020 FAFSA application and received an answer.
I have completed the
Skills Assessment (reading and writing) in the LCC Assessment Center.
If considered eligible:
I understand that I must complete a C
areer Assessment with the Adult Resource Center, and/or a C
areer Advising Appointment.
I understand that I must complete a Course Approval Appointment with the Adult Resource Center.
Name: Student Number:
Curriculum/Program of Study: Preferred Phone: Date of Birth:
Which of the descriptions
below fit you? You may check more than one.
Single Parent and/or Single Pre
gnant Woman: An individual who is unmarried or separated from a spouse, AND has sole or joint
custody of a minor child/children, AND/OR expecting the birth of a child.
Non-Traditional Career Trainee: An individual enrolled in an occupational program that has traditionally been underrepresented by
his/her gender.
Individual with Limited English Proficiency: An individual who has limited ability in spe
aking, reading, writing, or understanding the
English language AND whose native language is not English.
Individual with a Disability: An individual who has a physical or mental impairment that substantially limits one or
more major life
Economically Disadvantaged: An individual f
rom economically disadvantaged families, including foster children. This individual must
be one or more of the following: Pell Grant or other need-based financial assistance recipients.
Homeless Individuals: Homeless means lacking fixe
d, regular and adequate housing. You may be homeless if you are living in shelters,
parks, motels, hotels, public spaces, camping grounds, cars, abandoned buildings, or temporarily living with other people because
you have no place else to go. Also, if you are living in any of these situations and fleeing an abusive parent you may be considered
homeless even if your parent would otherwise provide a place to live.
Youth In or Aged Out of Foster Care System: This includes but is not limited to: Placements in foster care homes, foster homes of
elatives, group homes, emergency shelters, residential facilities, child care institutions, and preadoptive homes r
Out of workforce individual (Formerly Displaced Homemaker): An individual who is under-employed or unemployed and is
experiencing dif
ficulty in obtaining employment or upgrading employment, AND/OR (1) Has worked primarily without remuneration
to care for a home and family, and for that reason has diminished marketable skills; AND/OR (2) Has been dependent upon the
income of another family member but is no longer supported by that income; AND/OR (3) Is a parent whose youngest dependent
child will become ineligible to receive assistance under Part A of Title IV of the Social Security Act (42 U.S.C. 601 et seq.) not lat
than 2 years after the date on which the parent applies for assistance under this Title.
Job Title: Employer: Salary: (Weekl
y? Yearly?)
Starting and ending date:
_________________________________________ _______________________
_______________ ______________
List ALL Dep
If you are married and living in the same home, list spouse
Childrens names and date of birth:
Have you had any recent changes to income or household size
? Yes No
If yes, briefly describe the change: (Ex: Switched employers, new job)
Have you recei
ved any of the following between
2017-2018? Check all that apply:
SSI – Supplemental Assistance Income
SNAP Special Nutrition Assistance Program
Free or Reduced Lunch
TANF Temporary Assistance for Needy
Families/ DHHS Cash Assistance
Housing/Public/Section 8 Subsidy
Family/friends assistance
Spouse Income
Other Untaxed Income
Unemployment Compensation
Child Support Received
Alimony Received
I h
ave filed a 1920 FAFSA:
Yes No
I have completed all requests for verification from the Financial Aid Office:
Yes No
I understand that in order to be considered for this grant I must fulfill all requests for verification to financial aid.
Yes No
Please sign below to verify that you agree to the conditions and responsibilities of this award and that you assume responsibility for
knowing Lansing Community College policies.
If I am eligible for the Special Populations Grant, I understand that this grant provides funding for occupational education students only, and
that this grant is for students who are pursuing or have intent and commitment to pursue an occupational curriculum.
I give permission to the ARC at Lansing Community College to have access to my enrollment records, skill level scores, academic progress,
and grade information. I understand that grants are based on need. If I receive the Pell Grant or other grants/scholarships, I might not
receive tuition assistance from this grant.
I understand that funds for the Special Populations Grant is limited and may not be available in subsequent semesters.
Lansing Community College is an equal opportunity educational institution/employer. Lansing Community College programs and
activities are 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 other
status as protected by law, or genetic information.
I certify that all statements made on this application are true to the best of my knowledge, if requested, and I can provide proof
of information stated on this application to the Adult Resource Center and/or the Financial Aid Office.
Applicant’s Initials:
Applicants Signature: Date: