Northern Oklahoma College Financial Aid Student Data Form

NORTHERN OKLAHOMA COLLEGE FINANCIAL AID STUDENT DATA FORM

Please answer all questions completely.

Student Information: Name:______

Last First MI Maiden

SSN:______Date of Birth:______Phone:______

Local address: ______

Number Street City State Zip

Email address:______High school graduation date:______

MM/YY

I am a(n): I plan to begin or continue my enrollment: My course hours will be:

_____Entering Freshman ___Fall 2013 _____Full time (12+)

_____Continuing NOC Student ___Spring 2014 _____3/4 time (9-11)

_____Transfer student ___Summer 2014 _____1/2 time (6 -8)

_____Returning former student _____Less than ½ time

Month & year I plan to

Campus I plan to attend this year: Housing plans: graduate or transfer from NOC:

_____Tonkawa _____In dormitory May ______

_____Enid _____With parent or relative December ______

_____Stillwater OSU Gateway _____Off campus July ______

_____Stillwater (Nursing or Child Development)

_____University Center (Ponca City) Interested in Direct Loans? N / Y*

_____NOC & ______Technology Center *If “Y”, a Loan Request Form will be sent

_____NOC & Northwestern Okla. State Univ.*(Alva or Enid) to you for completion. It must be returned

*To request a consortium agreement, contact NOC Financial Aid Office. before loans will be awarded.

List below all colleges you are currently attending or have attended within the last three years. Provide an unofficial transcript..

SCHOOL / CITY / STATE / DATES ATTENDED / DEGREE EARNED

Please check the agencies you will be receiving financial assistance from:

______Air Force Tuition Assistance ______Oklahoma Promise

______Americorp ______Physician’s Manpower

______BIA: Which tribe?______SECC

______City of Enid/Vance Scholarship ______Vocational Rehabilitation

______Employer’s tuition assistance ______WIA

______Other: Please describe: ______

Scholarships: Please list source and annual amount below.

Source: Church/School/Civic / Type: Athletic/Scholastic/etc. / Amount per year / Confirmed / Pending

Child Care: Will you have out of pocket expense for child care while you attend school? (Daycare not paid by DHS or another agency). No ______Yes______Number of children ______Monthly amount per child ______

Optional: Consent for access: I do/do not (circle one) give permission for NOC to discuss my financial aid information with the following person(s):

Name Relationship Phone password Name Relationship Phone password

Unusual circumstances:

If you feel that your financial data provides an unrealistic picture of your financial strength, please explain on a separate sheet of paper and attach to this form. We will request additional documentation if warranted.

Signature: I certify that to the best of my knowledge, the information contained in this statement is correct and complete.

Signature Date