Fillable 2010-11 Sep2 GPA Formfillable

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2010-11 Sep2 GPA Formfillable

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Cal Grant GPA Verication Form
Cal Grants for students attending
a Community College during the
2010-11 Academic Year
TO BE FILLED OUT BY STUDENT Please print clearly using black ink only).
1. Your Social Security number: 2. Month/year of
high school
Re-enter your Social Security graduation
number: (REQUIRED)
3. Your name — last, rst, middle initial, as it is listed on your Social Security card and FAFSA:
Your Last Name Your First Name M.I.
4. Your date of birth: 5. Telephone number:
Month Day Year Area Code Phone Number
6. Your permanent mailing address:
Number and Street
City State Zip Code
7. Your E-mail address, if available: CSAC USE ONLY
8. Spring school code: If enrolled for spring 2010, enter your school code.
9. Fill in bubble if you are submitting a SAT, ACT or GED test score instead of a GPA.
Attach your applicable test score to this form, transcripts will not be accepted. You do not have to have your school ll out the FOR SCHOOL USE ONLY section
10. STUDENT CERTIFICATION: I have read the instructions and information accompanying this form. I understand that this Cal Grant GPA
Verication Form is used to determine Cal Grant eligibility and the GPA must be calculated as described on the attached GPA Calcula-
tion Instruction sheet. The information I have completed is true to the best of my knowledge, and I understand that it is illegal to report
false or misleading information. I understand that without a valid Social Security number and signature, this form will not be considered.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
_____________________________________________________________ ________________________________________
Student Signature Date
FOR SCHOOL USE ONLY (High schools MUST be fully accredited by the Western Association of Schools and Colleges [WASC] or an
equivalent regional accreditation agency to certify a Cal Grant high school GPA)
GPA IS BASED ON HIGH SCHOOL COURSEWORK? GPA VERIFIER’S SCHOOL CODE:
CALIFORNIA COMMUNITY COLLEGE REESTABLISHED GPA?
The signature of the high school or college ocial certies, under penalty of perjury, that the GPA is calculated as described on the attached GPA
Calculation Instruction sheet. The signature of a high school ocial also certies that his or her high school is fully accredited by the WASC or other
regional accrediting agency, or has a UC-approved course list as required by California regulations. I declare under penalty of perjury under the
laws of the State of California that the foregoing is true and correct.
_____________________________________________________________ ________________________________________________
Signature of School Ocial Name of School
_____________________________________________________________ ________________________________________________
Title of School Ocial Street Address of School
_____________________________________________________________ ________________________________________________
Date E-mail Address City State Zip Code
Mail completed form to: California Student Aid Commission, Cal Grant Operations, P.O. Box 419077, Rancho Cordova, CA 95741-9077
DEADLINE: SEPTEMBER 2, 2010 POSTMARKED
DO NOT SEND ACADEMIC TRANSCRIPTS
SEE BACK OF FORM FOR INSTRUCTIONS
REGIONAL ACCREDITATION AGENCY (HS ONLY) __________________
GPA CANNOT
BE ABOVE 4.00
VERIFIED STUDENT GPA:
.
Print Form
Instructions for lling out the Cal Grant GPA Verication Form
STUDENT INFORMATION SECTION. Please print clearly using black ink only. Filing deadline for 2010-11 awards is September 2, 2010
1. Your Social Security number: Enter your Social Security number (SSN) as it appears on your Social Security card and your FAFSA. (Valid SSNs
do not begin with 8, 9 or 000. If you believe your SSN begins with an 8, 9 or 000, then contact your local Social Security Oce to verify your
number.) Individual Tax Identication Numbers (ITIN) are not accepted.
2. Month/year of high school graduation: Enter the month and year you graduated, or plan to graduate from high school. Enter the month in a
two-digit format (for example: January should be appear as “01”; November should appear as “11”). Enter the year in a four-digit format (for
example: 2010 should appear as “2010”).
3. Your name: Print your full name as it appears on your Social Security card. Enter last name, rst name, middle initial.
4. Your date of birth: Enter your birth date. For example, June 25, 1992 would be entered as 06-25-1992.
5. Telephone number: Enter your area code and daytime telephone number.
6. Your permanent mailing address: Enter your permanent mailing address, city, state and ve-digit zip code.
7. Your E-mail address: Enter an E-mail address where you can be contacted for questions. This is optional.
8. Spring school code: Enter the school code for the school at which you were in attendance for spring 2010. Students graduating from high
school in spring 2010 should write in the College Board high school code number for their high school. This is the same code used for send-
ing SAT score information to the high school. Students who will be in college for the spring 2010 school term should write in the federal
code number of the college you are attending in spring 2010. Students who are not in college or high school for the spring 2010 school term
should leave this section blank.
9. Submitting a test score instead of a GPA: Complete questions 1 through 10, sign the form and attach a photo copy of the testing organization’s
score report and mail by the deadline to Commission. TRANSCRIPTS ARE NOT ACCEPTED.
The results from the GED, SAT or ACT tests must be submitted in lieu of a GPA if:
n You participated in a home schooling program or attended an unaccredited high school.
n You attended a high school or college outside of the United States and are unable to have those grades converted to a 4.00 scale or your
school did not grade in a manner that can be readily converted to a 4.00 scale.
n Students who have been out of school for ve years can choose to submit either test scores or submit their GPA.
– Scores from the California High School Prociency Examination (CHSPE) cannot be accepted in lieu of a high school GPA, but passing
the CHSPE does meet the high school graduation requirement of the Entitlement Cal Grant program. Also, grade reports, transcripts,
and other prociency certicates WILL NOT BE ACCEPTED.
10. Student signature: By signing this form, you certify that you have read these instructions and that the information you provided is correct. It is
illegal to report false or misleading information on this form and doing so may result in any Cal Grant award being revoked.
Once you have lled out the student information, take the form to your school and request that they verify your GPA. Be aware that if your
school will be electronically submitting your GPA to the California Student Aid Commission, you do not need to submit this form. It is your
responsibility to verify that the school will be submitting your GPA for you.
FOR SCHOOL USE ONLY SECTION
GPA IS BASED ON HIGH SCHOOL COURSEWORK: Fill in this bubble ONLY if the GPA is based on high school coursework.
CALIFORNIA COMMUNITY COLLEGE RE-ESTABLISHED GPA: Fill in this bubble ONLY if the GPA being certied is based on at least 16 but less than
24 units completed at a California Community College.
If the GPA is based on college units, and is not a reestablished GPA as described above, do not ll in any bubble.
GPA VERIFIER’S SCHOOL CODE: High schools use their College Board school code; colleges use their USED OPE ID
code.
VERIFIED STUDENT GPA: Fill in ALL three GPA spaces. Cal Grant GPAs are calculated on a 4.00 scale. High
Schools certifying GPAs MUST be accredited or have a UC approved course list in
order to verify GPAs. Students not attending accredited high schools should provide
either a GED, SAT or ACT score.
After the school completes the GPA information, fold form into thirds, insert into a #10 standard business envelope, apply the
appropriate postage and mail to:
California Student Aid Commission
Cal Grant Operations
P.O. Box 419077
Rancho Cordova, CA 95741-9077
REGIONAL ACCREDITATION AGENCY (High schools only) Please enter the Regional accreditation agency in
which your high school is accredited.
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