CRRSAA Student No FAFSA Questionnaire Student Name Campus Location Fort LauderdaleWest Palm Beach Program AS in EMSAS in NursingEMTParamedic The 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 a questionnaire and provide documentation of exceptional financial need in lieu of the FAFSA. 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. 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.