CRRSAA Student No FAFSA Questionnaire First Name Last Name Campus LocationPick a locationWest Palm BeachFort Lauderdale ProgramThe Coronavirus Response and Relief Supplemental Appropriations Act, 2021 (CRRSAA) was signed by the President of the United States on December 27, 2020. This act provides institutions with funding for students identified as having exceptional financial need. HCI College (the “College”) will provide $722,290 emergency financial aid grants to students for expenses or emergencies due to coronavirus (including eligible expenses under a student’s cost of attendance, such as tuition, food, housing, course materials, technology, healthcare, and childcare.)Students that have not completed the Free Application for Federal Student Aid (FAFSA) that wish to receive an award from these funds, will be required to complete this questionnaire in lieu of the FAFSA; students may also provide documentation of exceptional financial need. Documentation can include recent IRS tax form or W‐2 form, certification statement, etc. The completed questionnaire (and documentation) will be reviewed by a team at the institution to determine if the student has demonstrated exceptional need, the decision of the team is final and cannot be appealed. Students from this group determined to have exceptional need will be awarded $1,000.Please respond to the questions below: What is the total annual of income for your (and your spouse) or your parents’ household? What is the total number of members in your (and your spouse) or your parents’ household that you (and your spouse) or your parents’ support? Have you experienced any exceptional financial need or emergency expenses related to the coronavirus pandemic? If so, please provide a brief explanation.I certify that this information is true and accurate, and I am requesting an emergency student grant to help cover the cost of eligible expenses incurred due to the coronavirus pandemic. Student signature:Clear signature