2019-2020
VERIFICATION OF
HOMELESS STATUS
Office of Financial Aid
______________________________
SCC ID Number
A. Student Information (Please complete with blue/black ink only)
____________________________________________________________
Last Name First Name M.I
__________________________________________________________
E-mail address (if applicable)
______________________________
Phone number (if applicable)
I hereby authorize the certifying official at ________________________________________ to release information
Agency
regarding my homeless status (as of July 1, 2019 or later) to the SCC Financial Aid Office.
____________________________________________________________
Student Signature
______________________________
Date
UNAY20
REv. 3/19/19
B. Homeless Verification (to be completed by a Certifying Agency Official)
The above student may be eligible for financial aid as an independent student. When validation is complete, please return the
form to the SCC Financial Aid Office, 4000 Suisun Valley Road, Fairfield, CA 94534. Please check one box only and sign below.
Student was determined to be an unaccompanied youth who was homeless (on or after July 1, 2019) by a high
school or a high school district homeless liaison
Student was determined to be an unaccompanied youth who was homeless (on or after July 1, 2019) by the
director/coordinator of an emergency shelter or transitional housing program funded by the U.S.
Department of Housing and Urban Development (HUD).
Student was determined to be an unaccompanied youth who was homeless or at risk of being homeless (on or after
July 1, 2019) by the director/coordinator of a runaway or homeless youth basic center or
transitional living program.
HOMELESS means lacking fixed, regular and adequate housing, which includes living in shelters, motels, cars, or
temporarily living with other people because he or she had nowhere else to go.
UNACCOMPANIED means someone who is not living in the physical custody of his/her parent or guardian.
YOUTH means someone who is 21 years of age or younger, OR still in high school as of the day the FAFSA is signed.
INSTRUCTIONS: Students who answered “yes” on the Free Application for Federal Student Aid (FAFSA) to being homeless must
submit documentation to the SCC Financial Aid Office if this is the only criterion which makes the student independent.
This form has been provided to enable students to demonstrate their independent status for financial aid purposes. Acceptable
documentation, in lieu of this form, would be a signed letter (on letterhead) by any of the certifying officials listed in
section B.
____________________________________________________ ________________ _______________________
Print name and title of Certifying Official Date Phone Number
_________________________________________________________
Signature of Certifying Official
____________________________________________
Certifying Agency
