Fillable 20182019 Student Drug Conviction Worksheet (Southern Oregon State College)

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20182019 Student Drug Conviction Worksheet (Southern Oregon State College)

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Enrollment Services Center
1250 Siskiyou Blvd
Ashland, OR 97520
T: (541) 552-6600 F: (541) 552-6614
SOU ID Number
Student Last Name
Student First Name
2018–2019 Student Drug Conviction Worksheet
You are receiving this worksheet because you reported on your Free Application for Federal Student Aid (FAFSA) that you had a conviction
for possessing or selling illegal drugs or because you left the question blank.
Complete this worksheet to determine if you are eligible for federal student aid. These are the possible eligibility results:
“1” means your eligibility for federal student aid is not aected.
“2” means your drug conviction(s) aect eligibility for federal student aid for part of this school year. To receive federal student aid, you
need to tell the nancial aid oce at your college your “eligibility date” from question 11 on this worksheet. You can become eligible
earlier in the school year if you complete an acceptable drug rehabilitation program or pass two unannounced drug tests
administered by an acceptable drug rehabilitation program. Even if you are not eligible for federal student aid, you may still be
eligible for aid from your state or college.
“3” means you are not eligible for federal student aid for this school year unless you complete an acceptable drug rehabilitation program
or pass two unannounced drug tests administered by an acceptable drug rehabilitation program. Even if you are not eligible for
federal student aid, you may still be eligible for aid from your state or college.
ANSWER THE QUESTIONS BELOW AND FOLLOW THE INSTRUCTIONS AFTER EACH ANSWER.
1. Have you ever received federal student aid? Answer “No” if you have never received federal student grants, work-study, or loans.
You should also answer “No” if you have never attended college.
No If No, stop here. Sign the certification on page 2 and return this form to the Financial Aid Office. If Yes, go to
Yes
question 2 on this worksheet.
2. Have you been convicted for the possession or sale of Illegal drugs for an oense that occurred while you were enrolled and receiving federal
student aid (grants, work-study, or loans)? Only include federal and state convictions. Do not count any convictions that have been removed
from your record or that occurred before you turned age 18, unless you were tried as an adult.
No If No, stop here. Sign the certification on page 2 and return this form to the Financial Aid Office.
Yes If Yes, go to question 3 on this worksheet.
3. Did the oense for possessing or selling illegal drugs occur during a period of enrollment for which you were receiving federal
student aid (grants, work-study, or loans)?
No If No, stop here. Sign the certification on page 2 and return this form to the Financial Aid Office. If Yes, go to
Yes
question 4 on this worksheet.
4. Have you completed an acceptable drug rehabilitation program since your conviction?
An acceptable drug rehabilitation program must include at least two unannounced drug tests, and:
(1) Be qualied to receive funds from a federal, state or local government or from a federally or state-licensed insurance company; or
(2) be administered or recognized by a federal, state or local government agency or court, or a federally or state-licensed hospital, health clinic
or medical doctor.
Yes If Yes, you are eligible for federal student aid. Sign the certification on page 2 and return this form to the Financial Aid
Office.
No If No, go to question 5 on this worksheet.
5. Do you have more than two convictions for possessing illegal drugs? Only count convictions for oenses that occurred during a period of
enrollment for which you were receiving federal student aid (grants, work-study, or loans).
Yes If Yes, you are not eligible for federal student aid for this school year unless you completed an acceptable drug rehabilitation
program or passed two unannounced drug tests administered by an acceptable drug rehabilitation program. Even if you
are not eligible for federal student aid, you may still be eligible for state and other school aid.
No If No, go to question 6.
Page 1 of 2
Continued on next page
SOU ID Number
Student Last Name
Student First Name
6. Do you have more than one conviction for selling illegal drugs? Only count convictions for oenses that occurred during a period of enrollment
for which you were receiving federal student aid (grants, work-study, or loans).
Yes If Yes, you are not eligible for federal student aid for this school year unless you completed an acceptable drug
rehabilitation program or passed two unannounced drug tests administered by an acceptable drug rehabilitation
program. Even if you are not eligible for federal student aid, you may still be eligible for state and other school aid.
No If No, go to question 7.
7. Write the date of your last conviction for possessing illegal drugs here: 7
/ /
If you have no convictions for possessing drugs, skip to question 9.
8. If you have only one conviction for possessing drugs, add one year to the date in question 7,
and write that date here: 8 / /
If you have two convictions for possessing drugs, add two years to the date in question 7 and,
write that date here:
/ /
9. Write the date of your last conviction for selling illegal drugs here:
If you have no convictions for selling drugs, skip to question 11. 9
/ /
10. If you have only one conviction for selling drugs, add two years to the date In
question 9, and write the date here: 10 / /
11. Look at the dates you wrote in questions 8 and 10. If this is only one date, copy that date here:
If there are two dates, write the later one here: 11 / /
YOUR ELIGIBILITY DATE
WHAT TO DO WITH YOUR ELIGIBILITY DATE:
• Ifyoureligibilitydateinquestion11isbeforeJuly1,2018,youareeligibletoreceivefederalstudentaid. Sign the certification below
and return this form to the Financial Aid Office.
• IfyoureligibilitydatefallsbetweenJuly1,2018 andJune30,2019, sign the certification below and return this form to the Financial Aid
Office.
• IfyoureligibilitydateisafterJune30,2018, sign the certification below and return this form to the Financial Aid Office.
STUDENT CERTIFICATION
• Iherebydeclarethatallinformationreportedonthisdocumentistrue,complete,andaccuratetothebestofmyknowledge.
• Iunderstandthatanyfalsestatementormisrepresentation willbecausefordenial,reduction,cancellation and/orrepaymentoffinancialaid.
Daytime Phone ( ______ ) ___________________________________ E-mail Address _________________________________________
Student Signature ______________________________________________________ Date _______/________/________
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20182019 Student Drug Conviction Worksheet (Southern Oregon State College)

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Completed 26 August 2020

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