2020-2021 Unaccompanied Homeless Youth Certification
Request for Independent Financial Aid Status
Student ID Number Date
Last Name First Name M.I.
According to the College Cost Reduction and Access Act (CCRAA), the definition of an independent student includes youth who are unaccompanied
and homeless or unaccompanied, self-supporting, and at-risk of homelessness. The CCRAA uses the McKinney-Vento Act’s definitions of homeless, which
includes youth who lack a fixed, regular and adequate nighttime residence; and unaccompanied, which includes youth not in the physical custody of a
parent or guardian. The CCRAA also uses at-risk of homelessness to refer to students whose housing may cease to be fixed, regular, and adequate.
Please select one of the following options and submit this form to the Office of Financial Aid and Scholarships:
1. Provide Documentation
Acceptable documentation may include any of the following:
Letter from your high school homeless liaison (This is most common for incoming freshmen.)
If you are uncertain who this person is, please contact your guidance counselor.
Letter from a homeless, emergency, transitional or other housing authority confirming your current
A minimum of 2 corroborating letters from mental health professionals, social workers, mentors,
doctors, clergy, etc. confirming your current living circumstances
2. Student Interview
If you are unable to provide written documentation you may request an in-person interview with an
authorized Southern official from either the Financial Aid Office or Dean of Students Office.
If you select this option, you will be contacted by a Southern official to schedule an interview.
Preferred Contact Method:
Phone: Email:
Please note that the Dean of Students Office has a variety of programs to support students in all circumstances. If you
need help with food, housing or other types of support, please don’t hesitate to contact them at (203) 392-5556 or
By signing below, I certify that all information reported on this form is complete and correct. Please sign with a pen
or digital signature
. Electronic signatures are not accepted.
Student’s Signature Date
Warning: If you purposely give false or misleading information and/or fraudulently sign this form, you may be fined, sentenced to jail or both.
In addition, you will forfeit institutional eligibility. 6/2020
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