* This form must be submitted by the priority deadline to ensure a determination of aid eligibility before the Fee Due Date. Students may submit
the form after the priority deadline, but EFSC cannot guarantee that late submissions will be notified of aid eligibility prior to the Fee Due Date.
04/17/20
21V4D
FA Verification
2020-21
Dependent Student
Verification Form
V4 Custom Verification Group
Your 2
020-2021 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification.
About 30% of all FAFSA filers are selected for verification, which requires the school to collect documentation to review
the accuracy of FAFSA information. EFSC cannot award federal financial aid until this worksheet is processed.
Priority Deadlines*: Fall 202007/23/20 | Spring 2021 – 11/30/20 | Summer 2021 – 04/22/21
THIS DOCUMENT MUST BE ORIGINAL NO PHOTOCOPIES OR SCANS ACCEPTED
A. Student Information
B#
Last Name First Name M.I. Student ID
B. High School Completion Status
Please indicate your high school completion status when you begin college in 20202021:
I received or will have received a high school diploma.
I completed or will have completed secondary education in a foreign country and have a copy of the
“secondary school leaving certificate” or other similar document.
I have or will have passed a state authorized examination (GED test, HiSET, TASC, or other State-authorized
examination).
I completed or will have completed at least a two-year program that is acceptable for full credit toward a
bachelor’s degree.
I was homeschooled.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
2
Statement of Educational Purpose
I certify that I _________________________________________________________ am the individual signing this
(Print Student’s Name)
Statement of Educational Purpose and that the Federal student financial assistance I may receive will only be used
for educational purposes and to pay the cost of attending Eastern Florida State College for 2020-2021.
________________________________________ _______________
(Student’s Signature) (Date)
_________________________________________
(Student’s EFSC B Number)
Notary’s Certificate of Acknowledgement
State of ______________________________________________
City/County of _________________________________________
On ________________________, before me, _________________________________________, personally appeared,
(Date) (Notary’s name)
_______________________________________, and proved to me on the basis of satisfactory evidence of identification
(Printed name of signer)
________________________________________ to be the above-named person who signed the foregoing instrument.
(Type of unexpired government-issued photo ID provided)
WITNESS my
hand and official seal
________________________________________
(Notary’s Signature)
My commission expires on _________________________
(seal) (Date)
C. Identity and Statement of Educational Purpose To Be Signed With Notary
You must submit to EFSC:
A copy of the valid government-issued photo identification (ID) that is acknowledged in the notary
statement below, such as but not limited to a driver’s license, other state-issued ID, or passport;
AND
The original notarized Statement of Educational Purpose provided below.
3
D. Certification and Signatures
Each person signing below certifies that all of the information
reported is complete and correct. The student and one parent
whose information was reported on the FAFSA must sign and date.
Student’s Original Signature (cannot be signed electronically) Date
Parent’s Original Signature (cannot be signed electronically) Date
Eastern Florida State College
Office of Financial Aid
Building 2, Room 209
1519 Clearlake Road
Cocoa, FL 32922
Eastern Florida State College is committed to equal access/equal opportunity in its programs, activities, and employment.
For additional information, visit Eastern Florida State College: easternflorida.edu/go/equity.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
WARNING: If you purposely give
false or misleading information on
this worksheet, you may be fined,
sent to prison, or both.
QUESTIONS?
Financial Aid Specialists are available by phone at 321-433-7339 and via e-mail at finaid@easternflorida.edu.
E. Document Submission
You must submit via mail. This document MUST be original and cannot be e-mailed or uploaded.
1. BY MAIL
Mail your documentation to:
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