Fillable 2021-2022 Verification Worksheet Independent or Dependent Student (Southeast Arkansas College)

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2021-2022 Verification Worksheet Independent or Dependent Student (Southeast Arkansas College)

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2021-2022 Verification Worksheet
Independent or Dependent Student
Phone: (870) 543 - 5909 FAX: (870) 850 - 8516
E-mail: finaid@seark.edu
Your Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that before
awarding Federal Student Aid, we may ask you to confirm the information you reported on your FAFSA. To verify that you provided correct
information the financial aid administrator at your school will compare your FAFSA with the information on this worksheet and with any other
required documents. If there are differences, your FAFSA information may need to be corrected. You must complete and sign this
worksheet, attach any required documents, and submit the form and other required documents to the financial aid administrator at your
school. Your school may ask for additional information. If you have questions about verification, contact your financial aid administrator as
soon as possible so that your financial aid will not be delayed.
A. Student’s Information
_______________________________________________ _______________________________
Student’s Last Name First Name M.I. Student’s Identification (ID) Number
_______________________________________________ _______________________________
Student’s Street Address (include apt. no.) Student’s Date of Birth
_______________________________________________ _______________________________
City State Zip Code Student’s Email Address
_______________________________________________ _______________________________
Student’s Phone Number (include area code) Student’s Alternate Phone Number
B. Student High School Completion Status
Provide one of the following documents to indicate the student’s high school completion status when the student begins
college in 2021-2022:
A copy of the student’s high school diploma.
For students who completed secondary education in a foreign country, a copy of the “secondary school leaving
certificate” or other similar document.
A copy of the student’s final official high school transcript that shows the date when the diploma was awarded.
A state certificate or transcript received by a student after the student passed a State-authorized examination that the
State recognizes as the equivalent of a high school diploma (GED test, HiSET, TASC, or other State-authorized
examination).
An academic transcript that indicates the student successfully completed at least a two-year program that is
acceptable for full credit toward a bachelor’s degree.
For a student who was homeschooled in a state where state law requires the student to obtain a secondary school
completion credential for homeschooling (other than a high school diploma or its recognized equivalent), a copy of
that credential.
For a student who was homeschooled in a state where state law does not require the student to obtain a secondary
school completion credential for homeschooling (other than a high school diploma or its recognized equivalent), a
transcript, or the equivalent, signed by the student's parent or guardian, that lists the secondary school courses the
student completed and includes a statement that the student successfully completed a secondary school education in
a homeschool setting.
A student who is unable to obtain the documentation listed above must contact the financial aid office.
V4
Student Name: ________________________________________________ SSN or ID#_______________________
C. Identity and Statement of Educational Purpose
1. The student must appear in person at Southeast Arkansas College to verify his or her identity by presenting an
unexpired valid government-issued photo identification (ID), such as, but not limited to, a driver’s license, other state-
issued ID, or passport. The institution will maintain a copy of the student’s photo ID that is annotated by the institution
with the date it was received and reviewed, and the name of the official at the institution authorized to receive and
review the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose
provided below.
2. If the student is unable to appear in person at SOUTHEAST AR COLLEGE to verify his or her identity, the student
must provide to the institution.
(a) A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged in the notary
statement below, or that is presented to a notary, such as, but not limited to, a driver’s license, other state-issued
ID, or passport; and
(b) The original Statement of Educational Purpose provided below, which must be notarized. If the notary statement
appears on a separate page than the Statement of Educational Purpose, there must be a clear indication that the
Statement of Educational Purpose was the document notarized.
Statement of Educational Purpose
(Must Sign In Person At The SEARK Financial Aid Office Or In Front Of Notary)
I certify that I (Print Student Name) ______________________________________ am the individual signing this
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 SOUTHEAST ARKANSAS COLLEGE for 2021-2022.
_________________________________________________ _______________ _______________________
(Student’s Signature) (Date) Student’s ID number
Notary’s Certificate of Acknowledgement – (If you are unable to sign in person, you must
sign in front of a notary)
State of _____________________________________________________________________
City/County of ________________________________________________________________
On_____________________, before me, __________________________________________,
(Date) (Notary’s name)
personally appeared, __________________________________________, and proved to me
(Printed name of signer)
because of satisfactory evidence of identification _________________________________
(Type of unexpired government-issued photo
ID provided)
to be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal
(seal) ________________________________________
(Notary signature)
My commission expires on ___________________________
(Date)
Student’s Name: ______________________________________________ SSN or ID: _________________________
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D. Certifications and Signatures
Each person signing below certifies that all of the
information reported is complete and correct.
________________________________________ ________________________
Student’s Signature Date
________________________________________ ________________________
Spouse’s Signature (Optional) Date
________________________________________ ________________________
Parent’s Signature (Required) Date
(If parent information is reported on the FAFSA)
Return to the SEARK Financial Aid Office, by email, fax, regular mail, or in person.
E-Mail: finaid@seark.edu
Fax: (870) 850-8516
You should make a copy of this worksheet for your records. 03/08/2021
WARNING: If you purposely give false
or misleading information, you may be
fined, sent to prison, or both.
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2021-2022 Verification Worksheet Independent or Dependent Student (Southeast Arkansas College)

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Completed 10 May 2021

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