2019-2020
Form #4 - Custom Verification Worksheet
Your Free Application for Federal Student Aid (FAFSA) was selected for review process called “Verification”.
In this process we compare
your FAFSA with information on this worksheet and other required documents, such
as your 2017 IRS tax information. The Financial Aid
Staff will not make any financial aid payments to you until all verification and required documentation have been met and the necessary
correction have been made under the
financial aid program regulation (34CFR, art 668).
STUDENT INFORMATION
Last Name (Please Print) First Name
M.I.
Date of Birth
Peralta Student ID
Last 4-digits of SSN
Telephone Number to best reach you
STUDENT – HIGH SCHOOL COMPLETION STATUS
Pr
ovide one of the following documents that indicate you have, or will have a high school diploma or
GED
at
the
time you
begin taking
classes at Peralta Community College District. Peralta Community College District consists
of the following colleges: Berkeley City College,
College of Alameda, Laney College and Merritt College. Please
check the box indicating the document you are providing:
Copy of your high school diploma
Copy of your final official high school transcript that shows the date the diploma was awarded
Copy of your General Educational Development (GED) certificate or GED transcript
An academic transcript that indicates that you successfully completed at least a
two-year college program that is acceptable for
full credit toward a bachelor’s degree (Please note: this option will take additional time in completing your verification
for the evaluation of your transcripts)
If a State law requires a homeschooled 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 or a copy of your
transcript or equivalent signed by a parent or guardian
I do NOT have a high school diploma or GED.
If you are unable to obtain the documentation liste
d above, please contact the financial aid office. An additional form and/or
alternative documentation may be accepted.
IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE (TO BE SIGNED IN PERSON AT
THE CAMPUS FINANCIAL AID OFFICE)
You must appear in person at your home Financial Aid Office within the Peralta Community College District (PCCD) to verify your 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
passport (note: Military ID cannot be accepted). The institution
will maintain a
copy of your photo ID that is annotated by the institution
with the date it was received and reviewed along with the
name of the official at the institution authorized to collect your ID.
In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose provided below.
Statement of Educational Purpose: (To Be Signed in the presence of the Institutional Official)
I certify that I
am the individual signing this Statement of Educational
Print Name
Purpose and that the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of
attending PCCD for the 2019-2020 Award Year.
Student signature
Date
For Office Use Only/Date and Initials
Rev. 3/13/2019
