2008-09

DATA FORM

Student Financial Services Office Email: Phone: (775) 753-2399

1500 College Parkway Web site: www.gbcnv.edu/financial

Elko, NV 89801 FAX #: (775) 753-2390

GBC ID (9-digits) or SSN (9-digits)
(No Spaces)
Student Name: / N
Permanent Address (include apartment number) / Local Address (include apartment number):
Permanent City, State, Zip Code: / Local City, State, Zip Code: Local Phone:
( )
Permanent Phone: Cell # Work #
( ) ( ) ( ) / Birthdate: (MM/DD/YY): Email Address:
Month: Day: Year: @

HIGH SCHOOL

Did you graduate from high school? Yes or No If yes, please indicate what year?:______
If you did not graduate from high school, do you have a GED? Yes or No If yes, what year? ______Home School Program? Yes or No

Colleges, Universities, or Proprietary Schools previously attended:

Name of Institution Date Began Date Ended Degree or Certificate Earned
1.______/______
2.______/______
3. /

DEGREE OBJECTIVE

A degree objective is required to receive financial aid. DO NOT LEAVE BLANK AND CANNOT BE UNDECLARED OR UNDECIDED.
DEGREE OBJECTIVE :______(i.e. Associates of Arts, Cert. in Welding, etc.)

HOUSEHOLD IN COLLEGE

List other immediate household members attending a college/university, or trade school. Must be enrolled for 6 credits or more.
Name of Person(s) Relationship Name of college, university, or trade school
1.______/______
2. /

List the age(s) of your dependent child (ren) (who live with you or receive at least 50% of their support from you.

______Unborn child due date:______

CERTIFICATION:

Academic Award Year Covered by award(s): July 1, 2008 through June 30, 2009.

I hereby certify that this information is true, correct and complete. I agree to provide, if requested, any documentation to verify this information. I further affirm that I will report in writing within ten (10) calendar days and any changes in my academic status. I also authorize Great Basin College to apply for 2008-09 awarded Title IV federal funds to any outstanding current and/or minor prior year institutional charges incurred by myself. If I do not qualify for financial aid or should I choose not to accept the amount or type of financial aid awarded to me, I acknowledge that I will be responsible for any fees or tuition accrued. I also understand that if I withdraw from my classes I may be responsible to pay back funds to Great Basin College and the Department of Education. I give Great Basin College Student Financial Services permission to correct the information on my FAFSA that may be incorrect or inconsistent.
Student Signature______Date______Parent Signature______Date______
(required only if you are Dependent student)