California Community Colleges 2016-17 Board Of Governors Fee Waiver Application Form (Page 4 of 4) in pdf

California Community Colleges 2016-17 Board Of Governors Fee Waiver Application Form Page 4

ALIFORNIA

NFORMATION

RIVACY

State and federal laws protect an individual’s right to privacy regarding information pertaining to oneself. The California Information Practices Act of

1977 requires the following information be provided to financial aid applicants who are asked to supply information about themselves. The principal

purpose for requesting information on this form is to determine your eligibility for financial aid. The Chancellor’s Office policy and the policy of the

community college to which you are applying for aid authorize maintenance of this information. Failure to provide such information will delay and

may even prevent your receipt of financial assistance. This form’s information may be transmitted to other state agencies and the federal

government if required by law. Individuals have the right of access to records established from information furnished on this form as it pertains to

them.

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.

FOR OFFICE USE ONLY

 BOGFW-A

 BOGFW-B

Special Classification

RDP

 Student is not eligible

 TANF/CalWORKs

________

 Veteran

 National Guard

 Student