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State Form 50525 (R3/12-06)

INCARCERATED YOUTH OFFENDERS (SPECTER) GRANT APPLICATION STATE OF INDIANA STATE STUDENT ASSISTANCE COMMISSION OF INDIANA 2007-08 ACADEMIC YEAR APPLICATION

Student Information: Please Print or Type

Male First Name:

Female M.I.: Date of Birth: ______________________
MM/DD/CCYY

Last Name:

Social Security Number: _________ -______ -__________

Correctional Facility Name: _____________________________________________________________________________ City: ___________________________________________________________ State: IN Zip: _______________________ Are you an United States Citizen? Yes No Do you have a high school diploma or GED? Yes No Yes No

Have you previously received Specter Grant funds?

If yes, which year(s)? _________________________ Date: _______________________
MM/DD/CCYY

Signature: _____________________________________________________________ Facility Contact Information: Please Print or Type

Last Name: ___________________________ First Name: ______________________ Phone: _______________________
(Area Code) Telephone and Extension

Job Title: ___________________________________________________________________________________________ City: _______________________________________________________ State: IN Zip: _______________________
(Area Code) Telephone and Extension

E-Mail: _________________________________________________________________ Fax: _______________________ College: _________________________________________ DOC#: ________________ EPRD: _____________________
Student's DOC Number MM/DD/CCYY

I certify the above named student is eligible to be released within five years from the start of the term for which this application is being submitted (including a youth offender who is eligible for parole within such time); and is twenty-five (25) years of age or younger at the start of the term for which this application is being submitted; and that the student information reported above is correct.

Signature: _____________________________________________________________ College/University Information: Please Print or Type FAFSA Application Year: 200 FAA Last Name: City: - 200 FAFSA PC/EFC:$ First Name: State: IN Zip: E-mail: School Name: Title IV Code:

Date: _______________________
MM/DD/CCYY

Term:
Semester or Qtr CCYY

Phone:
(Area Code) Telephone

#Cr Hrs Enrolled: Tuition: $ Fees: $ Grant Amount Requested: $ Does any portion of the amount include charges for classes which were dropped - if so, how much and when was the class dropped?: $_______________ Drop Date: ______________________
MM/DD/CCYY

Semester Start Date: ______________ Semester End Date: ______________ Refund Period End Date: _______________
MM/DD/CCYY MM/DD//CCYY MM/DD/CCYY

I certify that the above named student is eligible to receive Specter Grant funds and has maintained enrollment beyond the refund period.

Signature: _____________________________________________________________

Date: _______________________
MM/DD/CCYY

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INCARCERATED YOUTH OFFENDERS (SPECTER) GRANT APPLICATION STATE OF INDIANA STATE STUDENT ASSISTANCE COMMISSION OF INDIANA 2007-08 ACADEMIC YEAR APPLICATION
State Form 50525 (R3/12-06)

1. The student must complete the 2007-2008 Free Application for Federal Student Aid (FAFSA) and submit it to the federal processor as instructed. The student also must complete the Student Information section and forward the Specter Grant Application to the Facility Contact. 2. The Facility Contact must review the Student Information section of the Specter Grant Application for accuracy, make any necessary corrections, and complete the Facility Contact section. When completed, the Facility Contact must send the Application to the representative in the financial aid office of the college/university where the student is enrolled. 3. The college/university financial aid representative must complete the college/university section of the Specter Grant Application including verifying that the student has maintained enrollment past the refund period and that the financial office has received the most recent FAFSA for the student. Students may receive up to $1,500.00 Specter Grant per calendar year and no more than five Specter Grants during his/her academic career. If the student is also eligible for SSACI Frank O'Bannon Grant funds, Specter Grant funds pay first, before SSACI Frank O'Bannon Grant funds. If Frank O'Bannon Grant funds are claimed by the college prior to Specter application review and payment, it will be necessary for the college to refund Frank O'Bannon Grant funds if an overpayment occurs. 4. The college/university financial aid representative must forward the Application to the SSACI Program Administrator for processing. CONTACT INFORMATION Indiana Department of Correction Representative: John Nally, Director of Education IDOC Indiana Government Center South 302 West Washington Street, 329 Indianapolis, IN 46204 Phone: 317-233-3111 Fax: 317-234-0956 Email: [email protected] Ball State University - 001786 Maralee Clayton Office of Scholarships and Financial Aid 245 Lucina Hall Muncie, IN 47306 Phone: 765-285-5600 Fax: 765-285-2173 Email: [email protected] Indiana State University - 001807 Debbie Youngen Office of Financial Aid 150 Tirey Terre Haute, IN 47809 Phone: 812-237-2979 Fax: 812-237-4330 Email: [email protected] Purdue University North Central - 001826 Bryant Dabney Office of Financial Aid 1401 South US 421 Westville, IN 46391 Phone: 219-785-5502 Fax: 219-785-5653 Email: [email protected] Incarcerated Youth Offenders (Specter) Grant Program Attn: Outreach Coordinator State Student Assistance Commission of Indiana (SSACI) 150 West Market Street, Suite 500 Indianapolis, IN 46204 Phone: 317-232-2350 Fax: 317-232-3260 Email: [email protected] Grace College - 001800 LaDonna R. Bloom Office of Financial Aid 200 Seminary Drive Winona Lake, In 46590 Phone: 574-372-5100, Ext.6164 Fax: 574-372-5144 Email: [email protected] Oakland City University - 001824 Caren Richeson Office of Financial Aid 138 North Lucretia Street Oakland City, IN 47660-1099 Phone: 812-749-1225 Fax: 812-749-1438 Email: [email protected] Ivy Tech Community College of Indiana-Terre Haute-008547 Penny Kinley Office of Financial Aid 8000 South Education Drive Terre Haute, IN 47802 Phone: 812/298-2297 Fax: 812-298-2294 Email: [email protected]

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