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									                                    Evergreen Valley College – Financial Aid Office
                           3095 Yerba Buena Road San Jose, California 95135 (408) 270-6460
                                                               DATA SHEET
                                                                2009-2010

Name:                                                                         Student ID:

Phone (Home or Cell)#:                                                        E-Mail:

A. STUDENT INFORMATION
   1. Have you been awarded financial aid at any other college or trade school for the 2009-2010 academic
      year?     Yes         No
          If yes, list name of school:

   2. Have you been awarded scholarship funds for the 2009-2010 academic year?                                        Yes             No
          If yes, list amount and source

   3. Will you receive Veteran’s Educational Benefits for the 2009-2010 academic year?                                       Yes            No
           If yes, indicate amount per month $         , and for how many months

   4. Did you EVER attend any college, trade school or university in the United States OR in another country
      after high school other than EVC or SJCC?       Yes      No
           If yes, how many transferable units* can you use toward your goal at EVC?
           Did you receive a degree, diploma, a certificate, or complete a program?       Yes        No
              List the degrees, diplomas, or certificates

   5. What is your academic goal? (Check only ONE)
         AA/AS Degree              Transfer to a four-year university
         Certificate                                     Other
                            List certificate program

B. STUDENT SIGNATURE
       I certify that all information on this form is true, complete, and accurate. I understand that false statements or
        misrepresentations will be cause for denial, reduction, or repayment of financial aid.

       By signing this form I agree to the following:
            o I consent to have any outstanding San Jose Evergreen Community College District charges for the 2009-
                2010 school year deducted from my financial aid disbursement;
             o    I am responsible for meeting with a counselor to determine my educational program and develop an
                  education plan;
             o    I must notify the Financial Aid Office of any changes in my program/major or my enrollment status; and
             o    I understand that changes to my enrollment status may affect my eligibility for aid and I may be required
                  to repay financial aid funds as a result of dropping a course or withdrawing from school.

   ________________________________________________________                                            ______________________
   Student Signature                                                                                   Date

       Transfer units must be evaluated by a SJECCD counselor to determine how many units you can use toward your goal at EVC. These units
        are used in the maximum time frame calculation. Refer to the Satisfactory Academic Progress policy in the EVC Financial Aid Handbook.

       Certificate programs must provide at least 16 units of instruction.

       Including, but not limited to Health Center, Library, A.S., Financial Aid, material fees, EOP&S, Enrollment and/or Non-Resident fees.

								
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