Fillable 1819V4Independentrevised

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1819V4Independentrevised

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2018-2019 V4 Custom Verification Worksheet - Independent
___________________________________________ ______________________________
Student’s Last Name First Name M.I. Student’s Identification (ID) Number
__________________________________________ ______________________________
Student’s Street Address (include apt. no.) Student’s Date of Birth
___________________________________________ ______________________________
City State Zip Code Student’s Email Address
___________________________________________ ______________________________
Student’s Home Phone Number (include area code) Student’s Alternate or Cell Number
High School Completion Status
Provide one of the following documents that indicate the student’s high school completion status when the
student will begin college in 2018-2019:
• A copy of the student’s high school diploma.
• A copy of the student’s final official high school transcript that shows the date when the diploma was
awarded.
• A state certificate or transcript received by a student after the student passed a state-authorized
examination that the state recognizes as the equivalent of a high school diploma (GED test, HiSET,
TASC or other state authorized examination).
• For students who completed secondary education in a foreign country, a copy of the “secondary
school leaving certificate” or other similar document.
• An academic transcript that indicates the student successfully completed at least a two-year program
that is acceptable for full credit toward a bachelor’s degree.
• For a homeschooled student from a state where state law requires the student to obtain a secondary
school completion credential for homeschool (other than a high school diploma or its recognized
equivalent), a copy of that credential.
• For a homeschooled student from a state where state law does not require the student to obtain a
secondary school completion credential for homeschool (other than a high school diploma or its
recognized equivalent), a transcript or the equivalent, signed by the student's parent or guardian, that
lists the secondary school courses the student completed and includes a statement that the student
successfully completed a secondary school education in a homeschool setting.
A student who is unable to obtain the documentation listed above must contact the financial aid office.
Statement of Educational Purpose
IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE
The student must appear in person at Jacksonville University to verify his or her identity by presenting a
valid government-issued photo identification (ID), such as, but not limited to, a driver’s license, other state-
issued ID, or p
assport. The institution will maintain a copy of the student’s photo ID that is annotated by
the institution with the date it was received and reviewed and the name of the official at the institution
authorized to collect the student’s ID.
In addition, the student must sign, in the presence of the institutional official, a Statement of Educational
Purpose.
If you are unable to appear in person, print the Statement of Educational Purpose from the Financial Aid
page of the JU website and complete it with a notary. The original completed Statement of Educational
Purpose must be mailed to:
Jacksonville University
2800 University Blvd N
Jacksonville, FL 32211
Certifications and Signatures
Each person signing below certifies that all of the
information reported is complete and correct.
___________________________________________
Print Student’s Name
__________________________________________
Student’s Signature (Required)
__________________________________________
Spouse’s Signature
_________________________
Student’s ID Number
_________________________
Date
_________________________
Date
WARNING: If you purposely give false
or misleading information you may be
fined, be sentenced to jail, or both.
Save the completed form and return as an email attachment to the appropriate financial aid counselor listed below:
• Online students and Speech Pathology students:
Brooke Sellars bsellar@ju.edu
• Students utilizing Veterans' benefits:
Kerry Boggus kboggus@ju.edu
All other students are sorted by last name.
• Students Last Names A - Ge
Sherry Bruggemann sbrugge@ju.edu
• Students Last Names Gh - N
Rob Lowman rlowman@ju.edu
• Students Last Names O - Z'
Misty Pippin mpippin1@ju.edu
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1819V4Independentrevised

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Completed 27 November 2019

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