First Name *

Last Name *

Student ID Number (if known)

Date of Birth *

Cell Phone Number

Email Address

How do you prefer to be contacted? *

Are you a U.S. Citizen? *

Have you applied for financial aid?

Gender *

Are you a PSEO student? (in high school taking college credits)

Have either of your natural or adoptive parents earned a 4 year degree? *

Have you made a connection with Accessibility/Disability Services at FDLTCC? (This question is voluntary)

If no, would you like more information about Accessibility/Disability Services? (This question is voluntary)

Do you give consent for TRIO to confirm if you are working with Accessibility/Disability Services?

Racial and Ethnic Background:

Hispanic *

American Indian/Alaskan Native *

Native Hawaiian/Pacific Islander *

Black/African American *

Asian *

White/Caucasian *

Have you ever taken college courses at another school?

Have you earned any college degrees? If yes, what degree(s)?

Family size (number of people living in your household)

Taxable Income (Line 15 of tax form 1040). If you used a parent/guardian's tax information on the FAFSA, use their tax information.

Please provide your e-signature below. *

Please select a signature verification type.

Parent e-signature (if you used a parent/guardian's tax information on the FAFSA).

Please select a signature verification type.

Terms of Submission:
By submitting this application, you acknowledge that all of the above information is correct and accurate to the best of your understanding.