Cal Grant GPA Verication Form
For 2012-13 Academic Year
TO BE FILLED OUT BY STUDENT
Please print clearly using blue or black ink only.
1. Your Social Security number: 2. Month/year of
high school
Re-enter your Social Security graduation (If currrently a HS senior, anticipated date)
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 2012, 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: MARCH 2, 2012 POSTMARKED
DO NOT SEND ACADEMIC TRANSCRIPTS
( SEE BACK OF FORM FOR INSTRUCTIONS)
GPA CANNOT
BE ABOVE 4.00
Instructions for lling out the Cal Grant GPA Verication Form
STUDENT INFORMATION SECTION. Please print clearly using blue or black ink only. Filing deadline for 2012-13 awards is March 2, 2012
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 appear as “01”; November should appear as “11”). Enter the year in a four-digit format (for
example: 2012 should appear as “2012”).
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, 1994 would be entered as 06-25-1994.
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 a “safe 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 2012. Students graduating from high
school in spring 2012 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 2012 school term should write in the federal
code number of the college you are attending in spring 2012. Students who are not in college or high school for the spring 2012 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 organizations
score report and mail by the deadline to Commission. TRANSCRIPTS and DIPLOMAS WILL NOT BE PROCESSED.
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 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 re-
ports, transcripts, and other prociency certicates WILL NOT BE ACCEPTED.
Only scores from the SAT reasoning test WILL BE ACCEPTED. Subject test scores will NOT BE PROCESSED.
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, obtain a certicate of mailing from post oce (optional) and mail to:
California Student Aid Commission
Cal Grant Operations
P.O. Box 419077
Rancho Cordova, CA 95741-9077
G-4 (09/2011)
Cal Grant GPA Calculation Instructions
High School GPA
A high school GPA is calculated on a 4.00 scale to two decimal
places (between 0.00 and 4.00). Do not use a weighted scale.
Convert any grades with extra weighting for honors and
advanced placement classes to a 4.00 scale before calculating
the GPA. GPAs calculated beyond a 4.00 scale will not be
accepted.
For students who have not yet graduated high school, calculate
the GPA using all academic course work for the sophomore
year, the summer following the sophomore year, the junior year,
and the summer following the junior year. The high school GPA
excludes physical education (PE), Reserve Ofcer Training
Corps (ROTC), and remedial courses. Remedial work is dened
as any course that is not counted toward high school graduation.
Failing grades must be included in the GPA calculation unless
the course has been retaken.
GPAs for “accelerated” high school juniors graduating in spring
2012 should be calculated using academic course work earned
during the student’s sophomore year and the summer following
the sophomore year, as well as all course work completed in the
junior year by the time of certication.
For students who are out of high school but have not earned
sufcient college level units to allow calculation of either a
college GPA or reestablished GPA or as explained below, the
GPA must be calculated from high school course work earned
from the student’s sophomore year onward, regardless of
whether the student graduated. Competitive Cal Grant awards
can be made to students who have not graduated high school.
Regular California Community College GPA
For purposes of computing a community college GPA for a Cal
Grant award, “nontransferable units” and “courses not counted
in the computation for admission to a California public institution
of higher education that grants a baccalaureate degree” mean
all courses except “Associate Degree Credit Courses” as dened
by Title 5, Chapter 6, Article 1, Section 55002(a) of the California
Code of Regulations.
Reestablished Community College GPA
A reestablished community college GPA is calculated on at least
16 but less than 24 semester units or the equivalent. For any
Cal Grant deadline, a school may submit either a reestablished
GPA or a “regular” community college GPA calculated on at
least 24 semester units, or the equivalent. A reestablished
GPA is good only for Competitive Cal Grant B consideration.
Only a California Community College may submit a
reestablished GPA.
College GPA
A college GPA is calculated on all college work completed,
except for nontransferable units and courses not counted in
the computation for admission to a California public institution
of higher education that grants a baccalaureate degree.
The denition of the phrases “all college work completed”
and “nontransferable units” and “courses not counted in the
computation for admission to a California public institution
of higher education that grants a baccalaureate degree” are
described below. A college GPA or a community college GPA
must be computed for a minimum of 24 semester units or its
equivalent regardless of the grades received. The phrase “all
college work completed” includes all coursework for which
grades are known to the ofcial reporting the GPA and that are
accepted for credit at the school reporting the GPA. Failing
grades must be included.
College GPA - Baccalaureate Degree Granting
Institution
College GPA - Associate Degree Granting
Institution
For purposes of computing a college grade point average by
a postsecondary institution that grants an associate degree,
“nontransferable units” and “courses not counted in the
computation for admission to a California public institution of
higher education that grants a “baccalaureate degree” are those
courses which do not earn credit for an associate degree at the
reporting institution.
College GPA - Non-degree Granting Institution
For purposes of computing a college GPA by a postsecondary
institution that does not grant a baccalaureate or an associate
degree:
(A) “nontransferable units” are those units which are not used in
satisfying requirements for earning a baccalaureate degree from
a California public institution of higher education that grants such
a degree;
(B) “courses not counted in the computation for admission to
a California public institution of higher education that grants a
baccalaureate degree” are any courses for which the earned
grade is not used in the computation of a GPA in determining
admission eligibility, whether or not units earned for the course
are transferable to such an institution.
There are four categories of GPAs used for Cal Grant award selection - High School, College, Regular
Community College and Reestablished Community College.
For purposes of computing a college GPA by an institution
that grants a baccalaureate degree, “nontransferable units”
and “courses not counted in the computation for admission to
a California public institution of higher education that grants a
baccalaureate degree” are those courses which do not earn
credit for a baccalaureate degree from the reporting institution.
If the GPA is based on college units, and is not a reestablished GPA as described above, do not ll in any bubble.