Please fill out your Application for Admission to the college before filling out this form.

*First Name:

*Last Name:

*While attending Providence, I plan to live:
 On Campus With Parents or Guardians Off Campus (I will be 21 years old by the first day of classes)

*I expect to take the following class load for my academic year at Providence:
 Full-Time (12 + units) per semester ¾ Time (9-11 units) per semester ½ Time (6-8 units) per semester Less than ½ time (0-5 units) per semester

*Do you believe you might qualify for any of the following grants? (check all that apply):
 Supporting Church Grant (a church that donates to Providence during the course of a fiscal year) Travel Grant (your home is outside of the state of California) Christian Ministry Grant (one or both of your parents are employed in full-time ministry positions) College Aid Grant (based upon financial need as determined by the FAFSA) Reformed Church Grant (membership in a recognized reformed denomination)

*Are you interested in receiving information about a low interest student loan?
 Yes No

*Are you interested in receiving information about how to apply for on-campus student employment?
 Yes No

I expect to receive financial assistance / scholarships from other public or private sources (e.g. high school awards, civic organizations awards, public company awards, church grants, etc.). List the source(s) and the amount(s) you expect to receive below:

Please use the space below to explain if you have any unique financial circumstances Providence should consider when creating your financial aid package:

By signing this form, I affirm that all information on this form and any attachments are complete and accurate to the best of my knowledge. If requested, I agree to provide documentation to support the information I have provided on this form.

*Your full name

*Date

Please type what you see: