s set forth in full in the Student Handbook/Course Catalog, Southern Crescent Technical College is an Equal Opportunity Ins
itution and does not
discriminate on the basis of race, color, national origin, sex, age or disability.
Revised 6-27-19
2019-2020 Georgia Residency
Verification Worksheet
Please Type or Print clearly in BLUE or BLACK ink
Student’s Last Name Student’s First Name Student’s M.I. Southern Crescent Student ID #
____________________________________________________________
Student’s Street Address (include apt. no.) Student’s Date of Birth
____________________________________________________________
City State Zip Code Student’s Email Address
____________________________________________________________
Student’s Home Phone Number (include area code) Student’s Alternate or Cell Phone Number
In order to determine HOPE Scholarship/Grant Eligibility, additional documentation is needed to verify Residency. Please complete this form and
return 1.) A completed copy of your 2017 & 2018 State of Georgia Tax Return (if an Independent Student) or a completed copy of your Parent(s)
2017 & 2018 State of Georgia Tax Return (if considered a Dependent Student) and 2.) A copy of one of the following requested documents from the
list on the right below.
Please select which documents are included with this verification request form and return to the Office of Financial Aid as soon as possible to complete
the review of your application for Financial Aid.
NOTE: Georgia Student Finance Commission (GSFC) requires a period of established Georgia Residency.
A. PROVIDED RESIDENCY DOCUMENTATION
Dependent Student
☐ 2017 Parent's GA State Tax Return AND
☐ 2018 Parent's GA State Tax Return
☐ A copy of Father's GA Driver's License AND
☐ A copy of Mother's GA Driver's License
- OR -
☐ A copy of Father's GA Voter Registration Card AND
☐ A copy of Mother's GA Voter Registration Card
Independent
Student
☐ 2017 Student's GA State Tax Return AND
☐ 2018 Student's GA State Tax Return
☐ A copy of Student's GA Driver's License
- OR -
☐ A copy of Student's GA Voter Registration Card
B. ESTABLISHED RESIDENCY HISTORY
PARENT STUDENT
Current State of Legal Residence
Date you became a Resident (Month/Year) / /
Date of High School Graduation/GED
/
Name of Final High School
Location of the High School (City, State)
City: State:
Name of the first Georgia College or
U
i
ersity atten
e
afte
High School
Start Date of the Georgia College or
U
i
ersit
atten
e
Mo
th/Yea
/
I certify that the information I am providing is true, complete, and correct to the best of my knowledge.
Student Signature: ___________________________________________ Date: _______________________________
Parent Signature (If Dependent):________________________________ Date: _______________________________
Office of Financial Aid
501 Varsity Road 1533 Hwy 19 South
Griffin, GA 30223 Thomaston, GA 30286
770-228-7368 p 706-646-6386 p
770-229-3029 f 706-646-6063 f
click to sign
signature
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signature
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