P.O. Box 35236  =  Fayetteville, NC 28303-0236  =  Phone (910) 678-8242   =   FAX (910) 678-8407

Date: ________________________________

SSN:  ________________________________                  Student ID#:     ____________________________

Name:  ______________________________________________________________________________________

Address:  ____________________________________________________________________________________

                                        (Street)                                                           (City)                                      (State)                (Zip Code)

Phone #: __________________________________________________

Curriculum:  ______________________________________________

Have you completed the FAFSA Application and submitted to Financial Aid Office?    YES      NO

Are you eligible to receive VA Benefits?        YES            NO        

Would you be willing to work off campus in a community service position?            YES      NO

Would transportation be a problem if you worked off campus?             YES      NO

If an off-campus work-study job is available, can FTCC forward your name and phone number to the Supervisor for the off-campus job?      YES      NO

If approved for Work Study, depending on the position you hold, a criminal background check may be conducted before you can begin working.

Please list prior work experience (skills/training)  _______________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

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Please list times you will be available to work:

(DO NOT WRITE BELOW THIS LINE)

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Financial Aid Office Use ONLY

               GPA:  _____________________                      Unmet Need:    _____________________ 

               EFC:  _____________________                       VA Benefits:      _____________________

Placement: __________________________________________________________________________________

NOTES:  _____________________________________________________________________________________________

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