READ CAREFULLY - ALL SPACES MUST BE ANSWEREDStudent Name* Last First Middle Permanent Mailing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone Work Phone Home Phone To receive aid, you must be seeking a degree or certificate at Frank Phillips College, and your program of study must be one that is eligible for financial aid and the classes you enroll in must apply to your degree or certificate. Program of study*High School Graduation Date* MM slash DD slash YYYY GED Completion Date* MM slash DD slash YYYY Did you graduate with Recommended, Distinguished or Honors status?* Yes No Statement of Student Eligibility Have you ever been convicted of a felony or an offense under Chapter 481, Health and Safety Code (Texas Controlled Substances Act), or under the law of another jurisdiction involving a controlled substance as defined by Chapter 481, Health and Safety Code?* Yes No Have you been convicted for the possession/sale of illegal drugs in a federal/state court while you were attending college?* Yes No The student is responsible to notify SFS of any class changed, (drop, Withdrawal) from the initial enrollment. The student is responsible to repay any Overpayment made to the student as a result of a class change.The student is responsible to notify SFS of any conviction from this date forward.I Hereby Certify that the information I have provided is true and correct. I understand that if I fail to provide accurate information, I may be required to reimburse Frank Phillips College any federal/state funds used on my behalf and additional penalties may be imposed Student Signature* Signature Date* MM slash DD slash YYYY
