Youth Verification Form
Louisiana College – Financial Aid Office – 1140 College Dr Box 582 Pineville, La. 71359
Phone (318) 487-7386 – Fax (318) 487-7449 – Email: email@example.com
You reported on your 2020-21 Free Application for Federal Student Aid (FAFSA) or California Dream Act Application
that at any time on or after July 1, 2019 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.
Student’s Name: ________________________________________________
LC ID: ______________________
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 Parish 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, 2019) by a high
school district homeless liaison.
• Student was determined to be an unaccompanied youth who was homeless (on or after July 1, 2019) 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, 2019) 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.