Cal Grant Dream Act AB 540 Affidavit

• CMC Student Name

  CMC Student Name * First Middle Last
• CMC Student ID # *
  Must be 8 digits.   Currently Entered: 0 digits.
• CMC Student Email *
  Confirm Email Address *
• Date

  Date / MM / DD YYYY

  
• *
  I have graduated from a California high school or have attained the equivalent, thereof, such as a High School Equivalency Certificate, issue by the California State GED Office or a Certificate of Proficiency, resulting from the California High School Proficiency Examination. I have NOT graduated from a California high school or have not attained the equivalent, thereof, such as a High School Equivalency Certificate, issue by the California State GED Office or a Certificate of Proficiency, resulting from the California High School Proficiency Examination.
• *
  I have attended high school in California for three or more years. I have NOT attended high school in California for three or more years.
• How many high schools did you attend between grades 9-12? *
  How many high schools did you attend between grades 9-12?

  One school Two schools Three schools Four schools
• School #1 *
• School #1 City, State *
• School #1 Date From

  School #1 Date From * / MM / DD YYYY

  
• School #1 Date To

  School #1 Date To * / MM / DD YYYY

  
• School #2 *
• School #2 City, State *
• School #2 Date From

  School #2 Date From * / MM / DD YYYY

  
• School #2 Date To

  School #2 Date To * / MM / DD YYYY

  
• School #3 *
• School #3 City, State *
• School #3 Date From

  School #3 Date From * / MM / DD YYYY

  
• School #3 Date To

  School #3 Date To * / MM / DD YYYY

  
• School #4 *
• School #4 City, State *
• School #4 Date From

  School #4 Date From * / MM / DD YYYY

  
• School #4 Date To

  School #4 Date To * / MM / DD YYYY

  
• Immigration Status *
  Immigration Status

  I am a non immigrant alien as defined by federal law, [including, but not limited to, a foreign student (F visa) or exchange visitor (J visa)] I am NOT a non immigrant alien (including, but not limited to, a U.S. citizen, permanent resident, or an alien without lawful immigration status).
• Affidavit *
  Affidavit

  I, the student, declare under penalty of perjury under the laws of the State of California that the information I have provided on this form is true and accurate. I, the student, understand that this information will be used to determine my eligibility for the nonresident tuition exemption for eligible California high school graduates. I, the student, hereby declare that, if I am an alien without lawful immigration status, I have filed an application to legalize my immigration status or will file an application as soon as I am eligible to do so. I, the student, further understand that if any of the above information is untrue, I will be liable for payment of all nonresident charges from which I was exempted and may be subject to disciplinary action by Claremont McKenna College.