Homeless Youth Verification Form
Students who have answered “yes” to being an unaccompanied youth who was homeless or at risk of
on the Free Application for Federal Student Aid (FAFSA) must have this
I am providing this letter of verification as a (check one, then list name, phone number, and other contact
☐ McKinney-Vento School District Liaison
☐ Director or Designee of a HUD-or RHYA-funded shelter
☐ Other; includes Director or Designee of a private or publicly funded homeless shelter or service
provider, financial aid administrator, personnel from college access programs such as TRIO and
GEAR UP, college or high school counselor, other mental health professionals, social worker,
doctor, and clergy.
As per the College Cost Reduction and Access Act (Public Law 110-84), I am authorized to verify this
student’s living situation. No further verification by a Financial Aid Administrator is necessary.
This letter is to confirm that (Name of Student) was:
☐ An unaccompanied homeless youth after July 1, 2017, living in a homeless situation, as defined by
Section 725 of the McKinney-Vento Act, and was not in the physical custody of a parent or
☐ An unaccompanied, self-supporting youth at risk of homelessness after July 1, 2017, This means
that, after July 1, 2017, he/she was not in the physical custody of a parent or guardian , provides for
his/her own living expenses entirely on his/her own, and is at risk of losing his/her housing.
Authorized Signature: Date:
Print Name: Telephone:
Please return this completed form to: GTCC Financial Aid Office, PO Box 309, Jamestown, NC 27282
AX to 336-217-8468.
Financial Aid Office P.O. Box 309 Jamestown, NC 27282
Phone: 336.334.4822 Option 3 Fax: 336.217.8468
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