Fillable Financial Aid Office 2019-2020 Custom Verification Worksheet V4 (Big Bend Community College)

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Financial Aid Office 2019-2020 Custom Verification Worksheet V4 (Big Bend Community College)

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Custom Verification – V4
Financial Aid Office
2019-2020 Custom Verification Worksheet – V4
Your 2019-2020 Free Application for Federal Student Aid (FAFSA) was selected for a review process called Verification. In this
process, the Financial Aid Office (FAO) will compare information from your FAFSA with the information you provide on this
worksheet and other required documents. The law says that before awarding Federal Student Aid we must complete this process. If
there are differences between your FAFSA and the information you are providing on this worksheet, the FAO is required to make
corrections to your FAFSA. Complete this form in PEN
. Incomplete worksheets will not be accepted.
A. Student Information
_______________________________ ________________________________ ______ ______________________________________
Last Name First Name M.I. Social Security Number
___________________________ _______________________________ __________________________________
Date of Birth Phone Number (including area code) Student ID Number
Please select the box that applies below and complete the remainder of this form accordingly:
☐ I am a DEPENDENT student. You were required to provide parental information on the FAFSA.
☐ I am an INDEPENDENT student. You were not required to provide parental information on the FAFSA.
B. Student High School Completion Status
Provide one of the following documents that indicate your high school completion status when you begin college in the 2019-2020
academic year:
☐ I have attached a copy of my High School Diploma.
☐ I have attached a copy of my final official high school transcript that shows the date when the diploma was awarded.
☐ I have attached the state certificate or transcript I received after passing a State-authorized examination that is a Recognized
Equivalent of a High School Diploma (i.e. GED).
C. Student Identity Verification & Statement of Educational Purpose:
Select one option and complete.
☐ I am appearing in person at the Big Bend Community College Financial Aid Office to verify my identity by presenting a valid
government-issued photo identification (ID), such as, but not limited to, a driver’s license; other state issued ID; or U.S. passport. The
institution will maintain a copy of the student’s photo ID that is annotated with the date it was received and the name of the official at
the institution authorized to review the student’s ID. In addition, I must sign, in the presence of the institutional official, the following:
Statement of Educational Purpose
I certify that I, _________________________________ (print student’s 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 _______________________________ (Name of Postsecondary
Education Institution) for 2019-2020.
______________________________________________ _________________________________________________
Student’s Signature Date Witnessing Financial Aid Official’s Signature Date
Custom Verification – V4
☐ I am unable to appear in person at Big Bend Community College to verify my identity and provide the Statement of Educational
Purpose. I understand I must attach a copy of the valid government-issued photo identification (ID), such as, but not limited to, a
driver’s license; other state issued ID; or U.S. passport and provide the Statement of Educational Purpose that is acknowledged in the
notary statement below. NOTE: Any costs incurred acquiring a Notary Public will not be reimbursed by Big Bend Community
College.
Statement of Educational Purpose
I certify that I, __________________________________ (print student’s 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 ________________________________ (Name of Postsecondary Education Institution) for 2019-2020.
___________________________________________________
Student’s Signature Date
Notary’s Certificate of Acknowledgement (Original hard copy must be mailed in – cannot be faxed)
State of _________________________ City/County of _____________________________________ on
___________________________ (date), before me __________________________________________ (notary’s
name) personally appeared _____________________________________ (printed name of student), and
provided to me on basis of satisfactory evidence of identification _______ (type of government-
issued photo ID provided) to be the above named person who signed the foregoing instrument.
WITNESS my hand and official seal: __________________________________________
Notary Public signature
______________________________________________
My Commission expiration date
G. Signatures
Each person signing this form certifies that all the information provided in this application and other financial aid documents is true
and correct. I agree that I have reviewed, understand and agree to the conditions, responsibilities and obligations in order to receive
financial aid for the 2019-2020 academic year as state in the Conditions of Award and Satisfactory Academic Progress Policy,
available on the financial aid website. The student and at least one legal parent (if a dependent student) must sign and date.
___________________________________________ _______________________________________________________
Student Signature Date Legal Parent or Spouse Date
Big Bend Community College does not discriminate on the basis of race, color, national origin, sex, gender, disability, or age in its programs or
activities. The following person(s) have been designated to handle inquiries regarding the non-discrimination policies. Kim Garza, Title IX
Coordinator, Building 1400, Office 1449 at (509)793-2010 or kimg@bigbend.edu or LoraLyn Allen, Coordinator of Disability Services, Building 1400,
Office 1472 at (509)793-2027 or loraa@bigbend.edu.
Return this form to:
Student Administrative Support Services - Financial Aid • 7662 Chanute Street N.E. • Moses Lake, WA 98837-3299
Phone: 509.793.2088 • Fax: 1.888.820.2896 • Email: faidinfo@bigbend.edu • http://www.bigbend.edu/admissions/financial-aid/
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Financial Aid Office 2019-2020 Custom Verification Worksheet V4 (Big Bend Community College)

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Completed 8 October 2020

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