Fillable 2020-2021 Drug Conviction Worksheet (Southwestern Michigan College)

Fill Online, Printable, Fillable, Blank 2020-2021 Drug Conviction Worksheet (Southwestern Michigan College) Form

Use Fill to complete blank online SOUTHWESTERN MICHIGAN COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

2020-2021 Drug Conviction Worksheet (Southwestern Michigan College)

On average this form takes 5 minutes to complete

The 2020-2021 Drug Conviction Worksheet (Southwestern Michigan College) form is 2 pages long and contains:

  • 1 signature
  • 12 check-boxes
  • 9 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Southwestern Michigan College

BROWSE SOUTHWESTERN MICHIGAN COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
(Flip for Questions on Back)
N
Print Name Student ID#
Instructions: On your FAFSA you either left question 23 blank or indicated that you have a drug
related conviction. The Federal government prohibits students from receiving Title IV financial
aid in certain circumstances when they have had a drug related conviction. Please check the
appropriate boxes, complete the appropriate lines, sign, and return this worksheet so we can
determine your eligibility for financial aid.
Note: On this worksheet count only federal or state convictions. Do not count convictions that have been
removed from your record or occurred before you turned 18 unless you were tried as an adult.
1. Have you ever received federal student aid? Answer “No” if you have never received
federal student aid (grants, loans, and/or work study). You should also answer “No” if you
have never attended college.
Yes If Yes, go to question 2.
No If No, stop, sign worksheet and return.
2. Have you ever been convicted for selling or possessing drugs, not including alcohol or
tobacco?
Yes If Yes, go to question 3.
No If No, stop, sign worksheet and return.
3. Did the offense for possessing or selling illegal drugs occur during a period of enrollment
for which you were receiving federal student aid (grants, loans, and/or work study)?
Yes If Yes, go to question 4.
No If No, stop, sign worksheet and return.
4. Have you completed an acceptable drug rehabilitation program since your last conviction?
An acceptable drug rehabilitation program must include at least two unannounced drug tests, and:
Be qualified to receive funds from federal, state, or local government or from a federally-
or state-licensed insurance company; or
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, stop, sign worksheet and return.
No If No, go to question 5.
5. Do you have more than two convictions for possessing drugs? Only count convictions
for offenses that occurred during a period of enrollment for which you were receiving
federal student aid (grants, loans and/or work-study).
Yes If Yes, stop, sign worksheet and return.
No If No, go to question 6.
Southwestern Michigan College
2020-2021 Drug Conviction Worksheet
Financial Aid Office, 58900 Cherry Grove Road, Dowagiac, MI 49047
Phone: 269.783.2143 Fax 269.783.2114 Email: finaid@swmich.edu
6. Do you have more than one conviction for selling illegal drugs? Only count convictions
for offenses that occurred during a period of enrollment for which you were receiving
federal student aid (grants, loans and/or work-study).
Yes If Yes, stop, sign worksheet and return.
No If No, go to question 7.
7. Write the date of your last conviction for possessing drugs here:_____/_____/_____
**If you have no convictions for possessing drugs, skip to question 9.
8. If you have one conviction for possessing drugs, add one year to the date in question 7,
and write that date here:______/______/______
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 drugs here:______/______/______
**If you have no convictions for selling illegal drugs, skip to question 11.
10. If you have only one conviction for selling drugs, add two years to the date in question 9,
and write that date here:______/______/______
11. Look at the dates you wrote in questions 8 and10. If there is only one date, copy that
date. If there are two dates, write the later one here:
______/______/______ (This is your Title IV Financial Aid eligibility date.)
By signing this worksheet, I certify that all the information reported here is complete and
correct. Warning: Anyone purposely giving false or misleading information on this worksheet
may be fined, sentenced to jail, or both.
Signature Date
Please sign and return this form to:
Financial Aid Office
Southwestern Michigan College
58900 Cherry Grove Road
Dowagiac, MI 49047
Fax 269-783-2114
Please note that submission of this form electronically should be encrypted to protect
any personal or confidential information.
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

2020-2021 Drug Conviction Worksheet (Southwestern Michigan College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 2 October 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document