2020-2021
FAFSA QUESTION 23
Central Alabama Community College
Student’s Name:_______________________________ Student Number:_________________________
Address:__________________________________ Phone Number:___________ Date of Birth:_________
You must complete this worksheet because you reported on your 2020-2021 FAFSA that you had a
conviction for possessing or selling illegal drugs or because you left question 23 blank.
Complete this worksheet to determine if you are eligible for Federal Title IV financial aid. Below are the
possible eligibility outcomes:
“1”
means your eligibility for Federal Title IV financial aid is not affected by question 23.
“2”
means your drug conviction(s) affect(s) eligibility for Federal Title IV financial aid for all or part of the 2020-
2021 school year. To receive Federal Title IV aid, you must report your “eligibility date” from question 11 on
this worksheet to the CACC Financial Aid Office. You may 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.
“3”
means you are not eligible for Federal Title IV financial aid for the 2020-2021 academic year unless you
complete an acceptable drug rehabilitation program or pass two unannounced drug tests administered by
an acceptable drug rehabilitation program.
If you need help completing this worksheet or have questions, please call the Federal Student Aid
Information Center at 1-800-433-3243.
Answer the questions below and follow the instructions after each answer.
1. Have you ever received Federal Title IV financial aid? Answer “No” if you have never received Federal
student grants, Federal student loans or Federal Work Study. You should also answer “No” if you have
never attended college.
2. Have you been convicted for the possession or sale of Illegal drugs for an offense that occurred while you
were receiving Federal Title IV financial aid (grants, loans and
/or Federal Work Study?) Only include
federal and/or state convictions. Do not include any convictions that have been removed from your record
or that occurred before you turned age 18, unless you were tried as an adult.
3. Did the offense for possessing or selling illegal drugs occur during a period of enrollment for which you
were receiving Federal Title IV financial aid (grants, loans and/or Federal Work Study?)
_____YES If YES, go to question 2 on this worksheet.
_____NO If NO, stop here. Sign the certification on the last page and return the form to the Financial Aid Office.
_____YES If YES, go to question 3 on this worksheet.
_____NO If NO, stop here. Sign the certification on the last page and return the form to the Financial Aid Office.
_____YES If YES, go to question 4 on this worksheet.
_____NO If NO, stop here. Sign the certification on the last page and return the form to the Financial Aid Office.
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 qualified 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.
5. Do you have more than two convictions for possessing illegal drugs? Only count convictions for offenses that
occurred during a period of enrollment for which you were receiving Federal Title IV financial aid (grants, loans
and/or Federal Work Study.)
_
_
_
__YES If Yes, you are not eligible for Federal Title IV financial 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.
_____NO If NO, go to question 6 on this worksheet.
Continued on to next page
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 Title IV financial aid (grants, loans and/or
Federal Work Study.)
7. Write the date of your last conviction for possessing illegal drugs on line 7. If you have no convictions for possessing
drugs, skip to question 9. 7: ______________________
8. If you have only one conviction for possessing drugs, add one year to the date in question 7, and write that date on line
8a. 8a:_______________________
If you have two convictions for possessing drugs, add two years to the date in question 7 and write that date on line 8b.
8b:_______________________
9. Write the date of your last conviction for selling illegal drugs on line 9. 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 on
line 10. 10:________________________
11. Look at the date(s) you wrote on lines 8a, 8b and 10. If there is only one date, copy that date on line 11. If there are
two or more dates, write the latest date on line 11. This is your eligibility date. 11._______________________
Student’s Name:_______________________________ Student Number:_________________________
_____YES If YES, you are eligible for Federal Title IV financial aid.
Sign the certification on the last page and return
the form to the Financial Aid Office.
_____NO If NO, go to question 5 on this worksheet.
_
__
__YES If Yes, you are not eligible for Federal Title IV financial 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.
_____NO If NO, go to question 6 on this worksheet.
_
_
___YES If Yes, you are not eligible for Federal Title IV financial 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.
_____NO If NO, go to question 6 on this worksheet.
_
_
___YES If Yes, you are not eligible for Federal Title IV financial 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.
_____NO If NO, go to question 6 on this worksheet.
_____YES If Yes, you are not eligible for Federal Title IV financial 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.
_____NO If NO, go to question 7 on this worksheet.
YOURELIGIBILITY DATE What you must do next:
Gather documentation to substantiate the dates and offenses you reported on this worksheet. Make copies
of that documentation and submit those copies, along with this signed worksheet, to the Financial Aid
Office. Ensure that your name and studentID # are clearly marked on all
documents submitted.
The Financial Aid Office will review this worksheet and your supporting documentation to determine if
you are eligible for Federal Title IV financial aid.
Student Certification:
Initial each statement:
______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.
______I understand that this document
must be received and reviewed prior to awarding of financial aid
and reviews may take up to a minimum of 2 weeks.
______________________________________
__________________
Student Signature
Date
1.
Please return the completed form and any required documentation to:
Central Alabama Community College Financial Aid Office in person, email: financial_aid@cacc.edu, or mail:
Alexander City Campus: 1675 Cherokee Road, Alexander City, AL 35010 OR
Childersburg Campus: 34091 US Highway 280, Childersburg, AL 35044
By electronic, typed, or written signature, I/we co
nf
irm that the statement above and information
provided is true and accurate to the best of my knowledge as of this date. Each person by signing below
certifies that all of the information reported is complete and correct.
click to sign
signature
click to edit
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