Fillable A. Student Information (Northwest State Community College)

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A. Student Information (Northwest State Community College)

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Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
Your FAFSA was randomly selected by the U.S. Department of Education for a review process called “Verification.” Verification must
be completed before your financial aid awards will be determined. If there are differences between your FAFSA and this
information, we will update your FAFSA and recalculate your Expected Family Contribution (EFC). Complete verification as soon as
possible so that your financial aid won’t be delayed. Your financial aid administrator will help you.
What You Should Do
1. Complete all sections of this worksheet
2. Submit the completed worksheet and any other required documents to the NSCC Financial Aid Office.
A. Student Information
Last Name First Name M.I
NSCC ID number
Street Address (include apt. no.)
Date of Birth
City, State, Zip Code
Phone Number
B. High School or Equivalent Completion
Please initial the following statement and provide one of the following documents to indicate the student’s high school
completion status when the student begins the college in 2019-2020:
A signed copy of the student’s final, official high school transcript. The transcript must be sent directly from the high
school.
A state certified transcript showing the student passed a state-authorized examination that the state recognizes as
equivalent of a high school diploma (GED test). The GED transcript must be sent directly from the state in which the
GED was issued.
For a student who was homeschooled, please submit a transcript, or the equivalent, signed and dated 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.
_______ I (student) have submitted a final high school transcript or other equivalent documentation to Northwest State
Community College that shows evidence of graduation or proof of equivalent from an accredited high
school or educational institution.
C. Certification and Signatures
By signing this worksheet, I certify that all the information reported on this worksheet is complete and correct. A delay in processing will
result if this form is not signed or if there is conflicting information on this worksheet. WARNING: IF you purposely give false or
misleading information on this form, you may be subject to fines and/or other penalties.
Student Signature________________________________________________________Date______________________
Parent Signature ________________________________________________________Date_______________________
(if dependent student)
Northwest State Community College does not discriminate on the basis of race, color, national origin, sex, gender identity, disability, religion
or age in its programs or activities.
2019-2020 Custom Verification
Group V4
Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
D. Proof of Identity – Student must appear in the financial aid office and provide proof of identity
The student must appear in person at Northwest State Community 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:
Identity and Statement of Educational Purpose
(To Be Signed at the Institution)
I certify that I, ____________________________ am the individual signing this Statement of Educational Purpose and that
(Printed Student’s Name)
the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending
Northwest State Community College for 2019-2020.
____________________________________________ N _________________
Student Signature Student ID Date
____________________________________________ ___________________________________________
Financial Aid Staff printed name Financial Aid Staff Signature
If the student is unable to appear in person at Northwest State Community 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 notarized 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.
Identity and Statement of Educational Purpose
(To Be Signed in the Presence of a Notary)
I certify that I, ____________________________ am the individual signing this Statement of Educational Purpose and that
(Printed Student’s Name)
the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending
Northwest State Community College for 2019-2020.
____________________________________________ N _________________
Student Signature Student ID Date
Notary’s Certification of Acknowledgement
State of ________________________________________City/County of________________________________________
On _________________________________________, before me, ____________________________________________
(Date) (Notary’s Name)
personally appeared, ____________________________________________, and proved to me on basis of satisfactory
(Printed name of signer)
evidence of identification ____________________________________________ to be the above-named person who
(type of unexpired government-issued photo ID provided)
signed the foregoing instrument.
WITNESS my hand and official seal ____________________________________________
(seal) (Notary signature)
My commission expires on ____________________ (Date)
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Completed 3 October 2020

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