Free 48418.pdf - Indiana

IMPACT VOCATIONAL OR JOB SKILLS TRAINING FINANCIAL INFORMATION
State Form 48418 (8-97) / IMP 0025

To be completed by the Office of Family and Children
Name of client:

Social Security number:

Training Provider:

Course of study:

To be completed by the Training Provider:
FEES EFFECTIVE FOR (PERIOD):

PROGRAM COSTS APPLICATION FEE REGISTRATION FEE

PER SEM / QTR / ____

PER YEAR

TOTAL PROGRAM

TUITION

BOOKS OTHER MANDATORY FEES (LIST) TOTAL COST

FINANCIAL AID GRANTS

PER SEM / QTR / ____

PER YEAR

TOTAL PROGRAM

SCHOLARSHIPS

OTHER AID

TOTAL FINANCIAL AID TOTAL BALANCE DUE

I certify this to be an accurate statement of costs.
Signature of Authorized School Official Title Date (month, day, year)