Bog FW Form English Accessible
Bog FW Form English Accessible
Bog FW Form English Accessible
This is an application to have your ENROLLMENT FEES WAIVED. If you need money to help with books, supplies,
food, rent, transportation and other costs, please complete a FREE APPLICATION FOR FEDERAL STUDENT AID
(FAFSA) or the California Dream Application (for eligible AB 540 students) immediately. The FAFSA is available at
www.fafsa.gov and the Dream Application is available at https://dream.csac.ca.gov. Contact the Financial Aid
Office for more information.
IMPLEMENTATION OF Assembly Bill 1899: Victims of Trafficking, Domestic Violence and other Serious Crimes
AB 1899, chaptered in September of 2012, provides for a non-resident enrollment fee exemption for “Victims of trafficking, domestic
violence and other serious crimes”. In addition, the legislation allows these students to apply for and, if eligible, receive financial aid
from programs administered by public postsecondary institutions or the state of California. Finally, the legislation provides that
enrollment fees shall be waived for these students who apply for and are eligible to receive Board of Governor enrollment fee waivers.
This PROMISE GRANT application is for California residents, students eligible under AB 540 and under AB 1899 as determined by the
Admissions or Registrar’s Office, and for homeless youth as determined by the Financial Aid Office. If you have not had your California
residency or eligibility status determined by the Admissions or the Registrar or homeless status determined by the Financial Aid Office,
see one of those offices to obtain the determination. Promise Grant eligibility cannot be determined until your status has been verified.
Has the Admissions or Registrar's Office determined that you are a California resident? Yes No
If no, has the Admissions/Registrar's Office determined you are eligible for a non-resident tuition exemption as an AB 540 student?
Yes No
If no, has the Admissions or Registrar's Office determined that you are eligible for a non-resident tuition exemption granted as a
result of you residing in the United States with a “T” or “U” visa (immigration status under Section 1101(a)(15)(T)(i) or (ii), or
Section1101 (a)(15)(U)(i) or (ii), of Title 8 of the United States Code)? Yes No
Has the Financial Aid Office verified that you have been without a residence in the last 24 months (homeless)?
If you have been homeless but not verified, check “Yes” and contact the Financial Aid Office. Yes No
Name: Student ID #
Last First Middle Initial
Email (if available): Telephone Number: (______)
If you answered "Yes" to any of the questions 1 - 10, you are considered an INDEPENDENT student for enrollment fee
waiver purposes and must provide income and household information about yourself (and your spouse or RDP if
applicable). Skip to Question #13.
If you answered "No" to all questions 1 - 10, complete the following questions:
11. If your parent(s) or his/her RDP filed or will file a 2016 U.S. Income Tax Return, were you, or will you be claimed on their tax return
as an exemption by either or both of your parents? Will Not FileYes No
12. Do you live with one or both of your parent(s) and/or his/her RDP? Yes No
If you answered "No" to questions 1 - 10 and "Yes" to either question 11 or 12, you must provide income and household
information about your PARENT(S)/RDP. Please answer questions for a DEPENDENT student in the sections that follow.
If you answered "No" or "Parent(s) will not file" to question 11, and "No" to question 12, you are a dependent student for all
student aid except this enrollment fee waiver. You may answer questions as an INDEPENDENT student on the rest of this
application, but please try to get your PARENT information and file a FAFSA so you may be considered for other student
aid. You cannot get other student aid without your parent(s’) information.
METHOD A ENROLLMENT FEE WAIVER
13. Are you (the student ONLY) currently receiving monthly cash assistance for yourself or any dependents from:
TANF/CalWORKs? Yes No
SSI/SSP (Supplemental Security Income/State Supplemental Program)? Yes No
General Assistance? Yes No
14. If you are a dependent student, are your parent(s)/RDP receiving monthly cash assistance from TANF/CalWORKs or SSI/SSP as
a primary source of income? Yes No
If you answered "Yes" to question 13 or 14 you are eligible for a CALIFORNIA COLLEGE PROMISE GRANT. Sign the
Certification at the end of this form. You are required to show current proof of benefits. Submit application and
documentation to the financial aid office.
METHOD B PROMISE GRANT QUESTIONS
15. DEPENDENT STUDENT: How many persons are in your parent(s)/RDP household? (Include yourself, your parent(s)/RDP, and
anyone who lives with your parent(s)/RDP and receives more than 50% of their support from your parents/RDP, now and through
June 30, 2019.) _________
16. INDEPENDENT STUDENT: How many persons are in your household? (Include yourself, your spouse/RDP, and anyone who
lives with you and receives more than 50% of their support from you, now and through June 30, 2019.) ___________
17. 2016 Income Information
(Dependent students should not include their own DEPENDENT STUDENT: INDEPENDENT STUDENT:
Income information for Q 17, a and b below.) PARENT(S)/RDP STUDENT (& SPOUSE’S/
a. Adjusted Gross Income (If 2016 U.S. Income Tax INCOME ONLY RDP) INCOME
Return was filed, enter the amount from Form 1040,
line 37; 1040A, line 21; 1040EZ, line 4). $______________ $__________________
b. All other income (Include ALL money received in
2016 that is not included in line (a) above (such as
Disability, child support, military living allowance,
Workman’s Compensation, untaxed pensions.) $______________ $__________________
TOTAL Income for 2016 (Sum of a + b) $______________ $__________________
The Financial Aid Office will review your income and let you know if you qualify for a CALIFORNIA PROMISE GRANT under
Method B. Submit application and documentation to the financial aid office.
If you do not qualify using Method A or Method B, you should file a FAFSA (for U.S. citizens or eligible non-citizens) or the
California Dream Application (for undocumented AB 540 students). The FAFSA is available at www.fafsa.gov and the Dream
Application is available at https://dream.csac.ca.gov/. Contact the Financial Aid Office for more information.
SPECIAL CLASSIFICATIONS ENROLLMENT Fee Waivers
18. Do you have certification from the CA Department of Veterans Affairs that you are eligible for a dependent's fee waiver?
Submit certification. Yes No
19. Do you have certification from the National Guard Adjutant General that you are eligible for a dependent's fee waiver?
Submit certification. Yes No
20. Are you eligible as a recipient of the Congressional Medal of Honor or as a child of a recipient?
Submit documentation from the Department of Veterans Affairs. Yes No
21. Are you eligible as a dependent of a victim of the September 11, 2001, terrorist attack?
Submit documentation from the CA Victim Compensation and Government Claims Board. Yes No
22. Are you eligible as a dependent of a deceased law enforcement/fire suppression personnel killed in the line of duty?
Submit documentation from the public agency employer of record. Yes No
If you answered "Yes" to any of the questions from 18-22, you are eligible for an ENROLLMENT FEE WAIVER
and perhaps other fee waivers or adjustments. Sign the Certification below. Submit application and
documentation to the financial aid office. Contact the Financial Aid Office if you have questions.
CERTIFICATION FOR ALL APPLICANTS: READ THIS STATEMENT AND SIGN BELOW
I hereby swear or affirm, under penalty of perjury, that all information on this form is true and complete to the best of my knowledge. If
asked by an authorized official, I agree to provide proof of this information, which may include a copy of my and my
spouse/registered domestic partner and/or my parent's/registered domestic partner’s 2016 U.S. Income Tax Return(s). I also
realize that any false statement or failure to give proof when asked may be cause for the denial, reduction, withdrawal, and/or
repayment of my waiver. I authorize release of information regarding this application between the college, the college district, and the
Chancellor's Office of the California Community Colleges.
Federal and state financial aid programs are available to help with college costs (including enrollment fees, books & supplies,
transportation and room and board expenses). By completing the FAFSA or the California Dream Application, additional
financial assistance may be available in the form of Cal Grants, Pell and other grants, work study and other aid.
I may apply for and receive financial assistance if I am enrolled, either full time or part time, in an eligible program of study
(certificate, associate degree or transfer).
Financial aid program information and application assistance is available in the college financial aid office.
The officials responsible for maintaining the information contained on this form are the financial aid administrators at the institutions to
which you are applying for financial aid. The SSN may be used to verify your identity under record keeping systems established prior
to January 1, 1975. If your college requires you to provide an SSN and you have questions, you should ask the financial aid officer at
your college for further information. The Chancellor’s Office and the California community colleges, in compliance with federal and
state laws, do not discriminate on the basis of race, religion, color, national origin, gender, age, disability, medical condition, sexual
orientation, domestic partnership or any other legally protected basis. Inquiries regarding these policies may be directed to the
financial aid office of the college to which you are applying.
Comments:
Certified by: Date: