​Book Grant/Loan Application​

 
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* indicates a required field

Student ID Number: *


Enter your Shasta College Student ID Number.

First Name (Student): *


Enter your first name.

Last Name (Student): *


Enter your last name.

Last 4 of Social Security Number (Student): *


Enter your social security number. If you do not have a social security number enter 999999999

Date of Birth: *


Enter your date of birth MM/DD/YY

Street Address OR PO Box (Student): *


Enter your street address or PO Box number.

City (Student) *


Enter the city where you receive your mail.

State (Student): *


Enter the state where you receive mail.

Zip Code (Student): *


Enter the zip code where you receive mail.

Please select phone number type (Student): *


This is to determine the source of the phone number.

Phone Number (Student): *


Enter your phone number.

Do you understand you must provide ONE reference? *


Either a "Parent Reference" OR "Another Reference not living with you must be provided.

My reference is: *


This tells us if the reference is a parent or Another Reference not living with the student.

First Name (Reference): *


Enter your reference's first name

Last Name (Reference): *


Enter your reference's last name.

Street Address OR PO Box (Reference): *


Enter the Street Address or PO Box for your reference.

City (Reference): *


Enter the city where the reference lives.

State (Reference): *


Enter the State where the reference lives.

Zip Code (Reference): *


Enter the Zip Code where the reference lives.

Phone Number (Reference): *


Enter the reference's phone number.

Email Address (Reference): *


Enter the reference's email address.

Do you (the student) currently attend High School? *


Are you currently attending a High School.

Are you (the student) part of the College Connection Program? *


This determines if the student is in the College Connection Program.

Do you (the student) live in the Dorms? *


Do you live in the dorms?

Are you (the student) considered an Out-of-State (OSR) Resident? *


Are you considered an Out-of-State resident?

I (the student) am applying for a: *


This is where the student tells us if they would like to apply for a book grant or loan.

In the amount of $: *


This is where the student indicates the amount of grant/loan funds they would like.

Validation *

 
Enter the characters in the image above to validate the form.

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