Fillable 2021-2022 Unaccompanied Homeless Youth and Unusual Circumstance Verification (Eastern Wyoming College)

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2021-2022 Unaccompanied Homeless Youth and Unusual Circumstance Verification (Eastern Wyoming College)

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Page | 1
Financial Aid Office
3200 West C Street
Torrington, WY 82240
p: 307.532.8224
f: 307.532.8222
financialaid@ewc.wy.edu
2021-2022
Unaccompanied Homeless Youth
and Unusual Circumstance Verification
Either through personal conversation with a Financial Aid staff member, or through the FAFSA, you have indicated that you received a
determination on or after July 1, 2020, that you were either an unaccompanied youth who was homeless, at risk of being homeless, or
have an unusual circumstance due to abuse or neglect, parental abandonment, or other situations where contact between you and your
parent(s) is non-existent.You may be eligible for additional educational services through Title X, Part C, Federal McKinney-Vento
Assistance Act. Additional information and resources are included on this form.
Beginning with the 2009-2010 academic year, the definition of an “independent student” was expanded to include any applicant
who had been verified during the school year in which the application is submitted as either:
• An unaccompanied youth who is a homeless child or youth, as such terms are defined in
section 725 of the McKinney-Vento Homeless Assistance Act; or
• An unaccompanied youth who is at risk of homelessness and is also self-supporting.
Critical Definitions
• McKinney-Vento and CCRAA Definition of Homelessness:
Children who lack a fixed, regular, and adequate nighttime residence which includes
Living in shelters, motels, cars, OR
Temporarily living with other people because the applicant had nowhere else to go.
The education subtitle of the McKinney-Vento Act is overseen by the U.S. Department of Education.
For more information, see: https://www2.ed.gov/policy/elsec/leg/esea02/pg116.html
• Unaccompanied Youth: Unaccompanied homeless youth are young people who lack safe, stable housing and who are not in
the care of a parent or guardian. They may have run away from home or been forced to leave by their parents. Unaccompanied
youth live in a variety of temporary situations, including shelters, the homes of friends or relatives, cars, campgrounds, public
parks, abandoned buildings, motels, and bus or train stations. 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.
• McKinney-Vento School District Liaisons: Under subtitle VII-B of the McKinney-Vento Homeless Assistance Act, every
school district is required to designate a liaison for students experiencing homelessness. Homeless liaisons have a number of
legal responsibilities under the Act, including identifying youth who meet the definition of homeless and are unaccompanied.
A local educational agency (LEA) homeless liaison, designated pursuant to 722(g)(1)(J)(ii) of the McKinney-Vento
Homeless Assistance Act; To find local liaisons: contact the Office State Coordinator for the Education of Homeless Children
and Youth. See: https://nche.ed.gov/data/
• HUD-funded Shelters: The U.S. Department of Housing and Urban Development (HUD) administers funding for homeless
shelters and services under Title IV of the McKinney-Vento Act. These funds are distributed to communities through a
competitive grant process. For more information, see: https://www.hudexchange.info/homelessness-assistance/
• RHYA-funded Shelters: The U.S. Department of Health and Human Services administers the Runaway and Homeless Youth
Act programs. These programs provide funding for Basic Centers, Transitional Living Programs, and Street Outreach
Programs that serve runaway and other unaccompanied homeless youth.
o For more information, see: https://www.acf.hhs.gov/fysb/programs/runaway-homeless-youth
o The director or a designee of the director of a program funded by the Runaway and Homeless Youth Act. To find
Runaway and Homeless Youth Act service providers go to: https://www.acf.hhs.gov/fysb/grants/fysb-grantees
• Unusual Family Circumstance: Young people who are not residing with a parent due to family circumstances such as abuse
or neglect, parental abandonment, or other situations where contact between the student and parent(s) is non-existent. This
student may meet the living circumstances described in the unaccompanied youth definition, or may be in a more stable living
situation such as living with a friend or relative on a more permanent basis. Students in this situation may need to complete
our Request for Independent Status Form.
Please review the above definitions as well as the information provided on Page 3 of this form. If a McKinney-Vento, HUD, or
RHYA designated official can confirm your status, you ONLY need to submit a Liaison Letter OR page 2 of this form. You do
NOT need to complete or submit page 3 or page 4. If a designated official cannot confirm your status, you must complete page 3
and page 4 (do not complete page 2) of this form and submit to the EWC Financial Aid Office.
RESOURCES AND DEFINITIONS
INSTRUCTIONS
Page | 2
Financial Aid Office
3200 West C Street
Torrington, WY 82240
p: 307.532.8224
f: 307.532.8222
financialaid@ewc.wy.edu
2021-2022 Unaccompanied
Homeless Youth Verification Form
For the Purposes of Federal Financial Aid
This form is to be completed by a designated official
I am providing this letter of verification as a (check one):
A McKinney-Vento School District Liaison
A director or designee of a HUD-funded shelter (shelter name):________________________________________
A director or designee of a RHYA-funded shelter (shelter name):_______________________________________
This letter is to confirm that __________________________________________________was:
Print student name
an unaccompanied homeless youth after July 1, 2020.
After July 1, 2020, the student listed above was living in a homeless situation, as defined by Section 725 of the
McKinney-Vento Act, and was not in the physical custody of a parent or guardian.
an unaccompanied, self-supporting youth at risk of homelessness after July 1, 2020.
After July 1, 2020, the student listed above was not in the physical custody of a parent or guardian, provides
for his/her own living expenses entirely on his/her own, and is at risk of losing his/her housing.
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. Should you have
additional questions or need more information about this student, please contact me at the number listed below.
Authorized Signature
Date
Print Name
Phone Number
Title
Agency
Return completed form to:
Eastern Wyoming College
Financial Aid Office
3200 West C Street
Torrington, WY 82240
(307) 532-8224 or 1-866-327-8996 Ext 8224
Fax: (307) 532-8222
Page | 3
HOUSEHOLD INFORMATION
Financial Aid Office
3200 West C Street
Torrington, WY 82240
p: 307.532.8224
f: 307.532.8222
financialaid@ewc.wy.edu
2021-2022
Unaccompanied Homeless Youth
and Unusual Circumstance Verification
Please review the “Resources and Definitions” section. Once you have determined which definition/circumstance most closely relates
to your situation, please submit the required documentation for one of the following:
1. A McKinney-Vento, HUD, or RHYA designated official can confirm your status. If a designated official can verify your
status as an unaccompanied homeless youth OR an unaccompanied, self-supporting youth at risk of homelessness on or
after July 1, 2020, please submit one of the following:
An Unaccompanied Homeless Youth Verification Form (provided on page 2) completed by a designated official, OR
o You do NOT have to complete page 3 or page 4 if you utilize this option. Just submit page 2.
A McKinney-Vento Homeless Liaison Letter provided by a designated official. The letter must be on official letterhead.
o You do NOT have to submit this form if you utilize this option. Just submit the letter.
2. A designated official cannot confirm your status. If a designated official cannot verify your status as an unaccompanied
homeless youth, an unaccompanied, self-supporting youth at risk of homelessness, or as a youth who has an unusual family
circumstance, please submit this completed form along with the following:
A typed (or neatly hand-written), signed statement that explains in detail to the extreme, the unique, and/or unusual family
circumstances that prevent you from obtaining/providing parent information for your financial aid application.
A signed statement from a third party who is knowledgeable of your family situation and can verify the reason you are unable to
provide your parents’ information. Appropriate third-party statements are from clergy, school counselors, teachers or similar
professionals. This third party should be someone unrelated to you. The statement should be on letterhead and should list the
person’s relationship to you and a contact number.
If you are living with a friend or relative (rather than living on your own), provide a signed statement from that friend or relative
confirming your living situation and any knowledge they have about your circumstances. The statement should include the
person’s relationship to you and a contact number.
DO NOT COMPLETE THE UNACCOMPANIED HOMELESS YOUTH VERIFICATION FORM ON PAGE 2.
* Please note: students whose circumstances most closely relate to Option 2 are not guaranteed approval as an Independent Student.
Documentation will be reviewed, and the Financial Aid Office may request additional information or an appeal to determine eligibility.
PLEASE NOTE: PAGE 3 AND PAGE 4 ONLY NEED TO BE COMPLETED
BY STUDENTS WHOSE STATUS CANNOT BE CONFIRMED BY A DESIGNATED OFFICIAL.
___________________________________________________________ ____________________ __________________________
Last Name First Name M.I. EWC Student ID Number Social Security Number (last four digits)
___________________________________________________________ _______________________________________________
Current Mailing Address (include apartment number) if you have one E-mail Address
___________________________________________________________ _______________________________________________
City, ST, Zip Phone Number (include area code)
I rent/own my own home.
I do NOT rent/own my own home.
Full name of household member
Age
Relationship to student
College attending/employer
Self EWC
STUDENT INFORMATION
REQUIRED DOCUMENTATION
Page | 4
CERTIFICATION AND SIGNATURE
Please note: ALL fields are required. If a section is left blank, or if all areas are marked “N/A” without a sufficient explanation,
the form will be returned to you and marked as incomplete.
UNACCOMPANIED SELF-SUPPORTING
Status
When was the last time you lived with your parent(s)?
2019 or earlier
2020 – Month: ___________________________
2021 – Month: ___________________________
2022 – Month: ___________________________
Where do your parent(s) currently reside? If
not known, please write/type “not known” on
the line for City. If both parents are
deceased, please write/type “N/A”
on the line for City.
City: _______________________________
State: _______________________________
Country (if not United States):
____________________________________
Do you currently have a job, or
have you had a job since July 1,
2020?
Yes, currently working
Yes, but no longer working
No
How are your food or grocery
needs being met (who pays for
them)? Select all that apply.
Self
Parent
Relative/Friend
Benefits
If you have a vehicle that you
drive to/from school or work,
please indicate the status of
ownership:
Vehicle paid for by self
Vehicle paid for by parent
Vehicle paid for by other
N/A (other mode of
transportation)
If you have a vehicle that you
drive to/from school or work,
please indicate who usually pays
for gas and/or vehicle
maintenance (oil changes, etc.):
Paid for by self
Paid for by parent
Paid for by other
N/A (other mode of
transportation)
Please also indicate who paid
for auto insurance:
Paid for by self
Paid for by parent
Paid for by other
N/A (other mode of
transportation)
If you have a cell phone, who
pays the monthly bill?
Paid for by self
Paid for by parent
Paid for by other
What is your parent(s)’ living situation?
On their own/with you
With a relative or friend
In a shelter
Unknown
Both parents are deceased
FIXED REGULAR ADEQUATE
Nighttime Residence
Is your current residence a
permanent or temporary
arrangement?
Permanent
Temporary
If temporary, will you be losing
your current housing within the
next six months to one year?
Yes
No
N/A (permanent)
If you are living with someone
else – are you sharing the
home/residence equally, or are
you more like a guest?
N/A – living alone
Shared residence
Treated as a guest
If you are living with someone
else- could the household
members ask you to leave?
N/A – living alone
Yes, they could ask
me to leave
No, they could not
ask me to leave
Do you stay in the same place
every night?
Yes
No
Do you have a key to the
place you are living?
Yes
No
How long have you lived at
your current address?
2 years or more
1-2 years
6 months to 1 year
Less than 6 months
How long do you plan to stay
at your current address?
2 years or more
1-2 years
6 months to 1 year
Less than 6 months
How long did you live at your
last address?
2 years or more
1-2 years
6 months to 1 year
Less than 6 months
How many bedrooms does
your current residence have?
No bedroom (car, etc.)
1 bedroom
2-3 bedrooms
4 bedrooms or more
How many bathrooms does
your current residence have?
No bathroom
1 bathroom or more
Are you sleeping in a public
area like a dining/living
room?
Yes
Yes, sleeping in another
type of public area
Sleeping in vehicle
No
Does your current residence
have heat, electricity and
running water?
Yes
No
Can you enter and leave the
residence as you please?
Yes
No
The undersigned certifies that the information provided on this form is accurate.
___________________________________________________________________________________________
Print Student Name Signature Date
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
10/2020
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2021-2022 Unaccompanied Homeless Youth and Unusual Circumstance Verification (Eastern Wyoming College)

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Completed 4 February 2021

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