Student Financial Assistance Program Application

Student Financial Assistance Program Application

UNITY • PROGRESS • LEGACY
SECTION I: Student Information
Full Name*

First NameMiddle NameLast Name
Student ID Number*
Classification*

FreshmanSophomoreJuniorSeniorGraduate Student
Major*
Expected Graduation Date*

MonthDayYear
Date
Current GPA*
Campus Address*
Permanent Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
ASU Email Address*
example@example.com
SECTION II: Enrollment & Financial Aid Status
Are you currently enrolled at Alabama State University?*

YesNo
Enrollment Status*

Full-TimePart-Time
Are you currently receiving Financial Aid?*

YesNo
Type(s) of Financial Aid*

Pell GrantScholarshipsLoansWork StudyOther
If Other Financial Aid, please specify
Have you received emergency assistance before (from any source)?*

YesNo
If yes, explain (prior emergency assistance)
SECTION III: Type of Assistance Requested
Amount Requested*
Type of Hardship (check all that apply):*

Loss of employmentMedical emergencyHousing insecurityUtility disconnection noticeTransportation emergencyFood insecurityAcademic-related expense (books, course fees, etc.)Other
If other, please describe:
SECTION IV: Description of Financial Hardship
Please provide a detailed explanation of your current financial hardship and how this assistance will help you remain enrolled at Alabama State University.
(Attach additional pages if necessary.)
Attach additional pages if necessary.

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SECTION V: Monthly Financial Snapshot
Income
Employment Income (Monthly)*
Financial Aid Refund (if applicable)
Family Support (Monthly)*
Other Income (Monthly)
Total Monthly Income*
Monthly Expenses
Housing / Rent (Monthly)*
Utilities (Monthly)*
Food (Monthly)*
Transportation (Monthly)*
Medical Expenses (Monthly)
Other Expenses (Monthly)
Total Monthly Expenses*
SECTION VI: Documentation Checklist

Note: Applications submitted without documentation may be delayed.
Documentation Attached*

Invoice or billMedical documentationTermination/reduction letterHousing/utility noticeCourse-related receiptsOther
If Other documentation, please specify
File Upload for supporting documents*

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VII: Certification & Authorization
I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that submission of false information may result in denial of assistance and possible disciplinary action.

If awarded, I agree to:
- Use funds solely for the approved purpose.
- Provide follow-up documentation if requested.
- Participate in a breife impact survey.
Student Signature*
Date of Student Signature*

MonthDayYear
Date
Should be Empty:

Student Financial Assistance Program Application

SECTION I: Student Information

SECTION II: Enrollment & Financial Aid Status

SECTION III: Type of Assistance Requested

SECTION IV: Description of Financial Hardship

SECTION V: Monthly Financial Snapshot

Income

Monthly Expenses

SECTION VI: Documentation Checklist

VII: Certification & Authorization