1.	Name
2.	Social Security #
2.	MCLA ID# (A#)
4.	Permanent Home Address:	Street City, State, Zip
5.	Phone: Cell Phone:
6.	Date of Birth:
7.	Your college grade level in 2008-2009 Academic Year:	Freshman Sophomore Junior Senior 5th or more undergraduate Graduate
8.	Planned Enrollment Status:	Full Time (12 credits or more per semester) Part Time Please indicate # credits for Fall 2008 and Spring 2009
9.	Indicate Program:	Bachelor's Degree Fast-Track Master's Degree Continuing Education Certificate Program
10.	Expected Graduation Date:	May January Month 2008 2009 2010 2011 2012 2013 2014 Year
11.	Housing for 2008-2009:	Campus Housing Off-Campus Apartment/Own Home Parent's Home
12.	Other Assistance: If you will receive any financial assistance (local scholarships, special tuition waivers, etc.) from sources other than College Financial Aid, please list them here and indicate the amounts:
13.	Are there any extraordinary circumstances affecting your family's financial situation? For example, if your income (or your parents' income) for 2008 will be substantially lower than it was in 2007 , please explain IN DETAIL.
14.	I certify that all information provided is complete and accurate to the best of my knowledge.
	Student Signature Date
	Email address