Andrikopoulos Family Scholarship - Laramie County Community ...

Andrikopoulos FamilySCHOLARSHIP APPLICATIONPlease complete this application and attach it to your written statement and transcripts.To insure proper consideration of application, hand all information in together to theFinancial Aid Office at LCCC.NameSocial Security NumberAddressStreetCity, State, ZIPTelephone NumberIncomeIncome earned from work by student(wages, salaries, tips, etc)Income earned from work by spouse orparent(s) (wages, salaries, tips, etc)Other benefits paid on your behalfChild support receivedOther untaxed income (VA, Military income,workers comp, pension)Actual prior year incomeor current year to dateEstimated income forremainder or current yearMarital Status:MarriedDivorcedSingleDo you currently care for a:Disabled childElderly parentMinor childrenHave you previously attempted college but were unable to continue?YesNoBy checking this box, I hereby certify the provided information is accurate to thebest of my knowledge. I also certify that I will allow the Scholarship and FinancialAid Office at LCCC to release any information that is applicable to this application._____________________Date