Grant Notification & Attestation Statement

Student Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Grant Award Amount

Enter the amount you have been approved for.

Please return this Notification & Attestation Statement to the Institute as soon as possible. No emergency financial aid grants will be disbursed to any otherwise eligible student who fails to or refuses to sign this acknowledgment statement. The Institute will make emergency need-based grants to eligible students until the grant funding received from the U.S. Department of Education is depleted. Students who return this attestation statement after the grant funding is depleted will not receive an emergency financial aid grant.

I accept the grant award provided to me from funding made available to McDougle Technical Institute under Coronavirus Response and Relief Supplemental Appropriations Act, 2021 (CRRSA).

I certify the following:(Required)

All information provided in this Attestation Statement is true and correct to the best of my knowledge.

I have experienced additional expenses due to the disruption caused by coronavirus.

I understand that any money awarded from this grant is to be used for any component of my cost of attendance or for emergency costs that arise due to coronavirus, such as tuition, food, housing, health care (including mental health care), or childcare.

I understand that I have the option, but that I am not required, to apply some or all of the Grant Award Amount toward my outstanding balance due to the Institute. Whether I choose to apply some or all of my Grant Award Amount toward my outstanding balance due to the Institute will not change my Grant Award Amount.

Please indicate your choice for the disbursement of your Grant Award Amount:(Required)

By submission of this application you affirmed the following:(Required)

I certify that I am empowered to execute this application.. I understand that my signature on this written declaration has the same legal effect as an oath or affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true. I understand that falsification of any material information on this application may result in criminal penalty or administrative action, including termination. I understand that an electronic signature shall have the same force and effect as a written signature. My signature certifies that the information provided for this request and all accompanying documentation is true and correct to the best of my knowledge.

Student Signature(Required)

Date(Required)

Phone

This field is for validation purposes and should be left unchanged.