Name Change Financial Aid Application

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Applicant must be 18 years of age or older and a resident of Lehigh, Northampton, Monroe, Montgomery, Berks, Bucks, Chester, Delaware, Lancaster, Luzerne, Lackawanna, Wayne, Pike, Carbon, Columbia or Schuylkill County in Pennsylvania. Applications from any other locality will be automatically declined.

Applications that are not complete (including sections on income and expenses) may not be considered.

Please provide as much information as possible in the fields below

Financial Aid Application - Name Change

  • Personal Information

  • Financial Information

  • Health Care Provider Certifications

  • Other Information

  • Affirmation