2019-2020
Unaccompanied Homeless
Youth Verification Form
Feather River College Financial Aid Office 570 Golden Eagle Avenue, Quincy CA 95971
Phone (530) 283-0202 ext. 603 Fax (530) 283-4659 Email: financialaid@frc.edu
www.frc.edu/financialaid
UNHY20
Page1
(Agency Name)
(Agency Name)
You reported on your 2019-2020 Free Application for Federal Student Aid (FAFSA) or California Dream Act Application
that at any time on or after July 1, 2018 you are/were an unaccompanied youth who is homeless or are a self-supporting,
unaccompanied youth at risk of being homeless. Please have this form completed by the authorizing individual, sign, and
submit along with any required documentation to the Financial Aid Office. Include your FRC student ID number on all
documentation submitted. You must renew your status every academic year, see reverse for renewal option.
A. Student Information
Student’s Name: ________________________________________________ FRC ID: ______________________
B. Definitions
Homeless means lacking fixed, regular, and adequate housing. You may be homeless if you are living in shelters, parks,
motels, hotels, public spaces, camping grounds, cars, abandoned buildings, or temporarily living with other people
because you have nowhere else to go. Also, if you are living in any of these situations and fleeing an abusive parent,
you may be considered homeless even if your parent would otherwise provide a place to live.
Unaccompanied means you are not living in the physical custody of your parent or guardian.
C. Letter of Verification Check one
I am providing this letter of verification as:
A McKinney-Vento School District Liaison
A director or designee of a HUD-funded shelter: ___________________________________________________
A director or designee of a RHYA-funded shelter: __________________________________________________
A financial aid administrator: ___________________________________________________________________
D. Confirmation of Student Status Check the appropriate box to confirm status
Student was determined to be an unaccompanied youth who was homeless (on or after July 1, 2018) by a high
school district homeless liaison.
Student was determined to be an unaccompanied youth who was homeless (on or after July 1, 2018) by
the director/coordinator of an emergency shelter or transitional housing program funded by the U.S.
Department of Housing and Urban Development (HUD).
Student was determined to be an unaccompanied youth who was homeless or at risk of being homeless
(on or after July 1, 2018) by the director/coordinator of a runaway or homeless youth basic center or
transitional living program.
As per the College Cost Reduction and Access Act (Public Law 110-84), I am authorized to verify this student’s living situation. No
further verification by the Financial Aid Administrator is necessary. Please contact me at the number listed below to verify or to request
additional information regarding this student.
Print Name:
Title:
Agency:
Authorized Signature:
Clear Form
2019-2020
Unaccompanied Homeless
Youth Verification Form
Feather River College Financial Aid Office 570 Golden Eagle Avenue, Quincy CA 95971
Phone (530) 283-0202 ext. 603 Fax (530) 283-4659 Email: financialaid@frc.edu
www.frc.edu/financialaid
UNHY20
Page2
(Student Name)
F. Certification and Signatures Each person signing this worksheet certifies that all of the information reported on it is
complete and correct. The student whose information was reported on the FAFSA must sign and date. Warning! If you purposely
give false or misleading information you may be fined, sentenced to jail, or both.
Student Signature: _____________________________________________________ Date__________________
This worksheet must be signed and dated to be valid. Electronic and/or digital signatures are not valid.
For Office Use Only
Status Verified:
Update RNAOV20 Dependency field to I for Independent
Eligible Third party designation
Eligible FAA determination (completed intake questionnaire attached)
Eligible Renewal status confirmed
Status Not Verified: Ineligible
Comment(s):
Processed/Reviewed By:
Date:
E. Request to Renew Status
By signing below you are confirming that your status has been previously approved by Feather River College Financial
Aid Office and you are requesting a renewal of your status for the academic year. Please complete this section, sign,
date, and submit to the Financial Aid Office.
I, ______________________________________________, request to renew my status as an unaccompanied homeless
youth or self-supporting and at risk of being homeless, and certify that my circumstances have not changed since last
year.
Are you residing in any FRC campus housing (Dorms, Meadows, Pines)? YES NO
If yes, where would you live if you were not? ___________________________________________________________
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome