PATH Application - John A. Logan College

Name *

First

Last

Semester *

JALC ID Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

County *

Phone *

Alternative Phone

JALC E-Mail Address *

Best form of Contact (select one or both) *

JALC email
Phone call

Birth Date *

Sex *

Program of Study/Major *

Layout

Are you a U.S. Citizen? *

Are you a Veteran? *

Are you currently receiving a Pell Grant or public assistance? *

To be eligible for PATH, you must meet one of the following criteria, and be able to provide verifying documentation. Please check all that apply *

Low income (receiving federal aid, such as SNAP, Medicaid, or TANF)
First generation college student
Minority or underrepresented student population
Incumbent worker – (already in the workforce looking to continue their education and advance their careers in the nursing or healthcare pathway in Illinois)

Do you need assistance with (can select multiple) *

Books
Childcare
Other

If you chose "Other" please put that information here

In the space below, please provide a description of your situation. Include what obstacles you have that could prevent you from successfully completing a certificate or degree program. *

The information on this form is confidential and will help determine eligibility for the PATH Grant.

Students must file a FAFSA. PATH grant recipients must meet with the PATH Grant Coordinator at the beginning of each semester. The Office of Financial Aid and the Accessibility & Resource Office will determine eligibility based upon the FAFSA.

I declare that the information given here is true and correct to the best of my knowledge. I authorize the Accessibility & Resource Office access to my student records, including academic records and financial awards and any other information pertaining to my enrollment at John A. Logan College. I understand that PATH has limited funding and completion of this application does not guarantee that I will be awarded funding through the PATH Grant. *

Agree to the Policy and Release of Information