PATH Application - 51吃瓜 A. Logan College

Name *

First

Last

Semester *

JALC ID Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

County *

Phone *

Alternative Phone

JALC E-Mail Address *

Best form of Contact (select one or both) *

JALC email
Phone call

Birth Date *

Gender Identity *

Program of Study/Major *

Are you a U.S. Citizen? *

Are you a Veteran? *

Are you currently receiving a Pell Grant or public assistance? *

To be eligible for PATH, you must meet one of the following criteria, and be able to provide verifying documentation. Please check all that apply *

Low income (receiving federal aid, such as SNAP, Medicaid, or TANF)
First generation college student
Minority or underrepresented student population
Incumbent worker 鈥� (already in the workforce looking to continue their education and advance their careers in the nursing or healthcare pathway in Illinois)

Do you need assistance with (can select multiple) *

Books
Resources
Other

If you chose "Other" please put that information here

In the space below, please provide a description of your situation. Include what obstacles you have that could pr51吃瓜 you from successfully completing a certificate or degree program. *

The information on this form is confidential and will help determine eligibility for the PATH Grant.

Students must file a . PATH grant recipients must meet with the PATH Grant Coordinator at the beginning of each semester. The Office of Financial Aid and the Accessibility & Resource Office will determine eligibility based upon the FAFSA.

I declare that the information given here is true and correct to the best of my knowledge. 聽I authorize the Accessibility & Resource Office access to my student records, including academic records and financial awards and any other information pertaining to my enrollment at 51吃瓜 A. Logan College. 聽I understand that PATH has limited funding and completion of this application does not guarantee that I will be awarded funding through the PATH Grant. *

Agree to the Policy and Release of Information