SECTION I (Instructions)
Students who answered ‘Yes’ on their Free Application for Federal Student Aid (FAFSA) to
being homeless must submit documentation to the college Financial Aid Office, if this is the only
criterion which makes a student Independent. This form has been provided to enable students to
demonstrate their independent status for financial aid purposes. Acceptable documentation, in
lieu of this form, would be a signed letter (on letterhead) by any of the certifying officials listed in
Section III. If you are unable to provide documentation, please schedule an appointment with a
Financial Aid Officer.
SECTION II (to be completed by Student)
I hereby authorize the certifying official at ______________________________________________ to release
information regarding my homeless status (as of July 1, 2018 or later) to the college Financial Aid Office.
SECTION III (to be completed by Certifying Official)
The student above may be eligible for financial aid as an independent student. Please check only one option and
sign below.
□
Student was determined to be an unaccompanied youth who was homeless (on or after July 1,
2018) by a high school or school district homeless liaison.
□
Student was determined to be an unaccompanied youth who was homeless (on or after July 1,
2018) by the director of an emergency shelter or transitional housing program funded by the
U.S. department of Housing and Urban Development.
□
Student was determined to be an unaccompanied youth who was homeless or were self-
supporting and at risk of being homeless (on or after July 1, 2018) by the director of a runaway
or homeless youth basic center or transitional living program.
Print Name of Certifying Official Phone Number Date
Signature of Certifying Official E-mail Address
Title of Certifying Official
S
TUDENT
I
NFORMATION
RETURN TO FINANCIAL AID OFFICE:
_____________________________
Student ID#
________________________________________________________
Last Name First Name M.I.
Student Signature
Date
201
9-2020
HOMELESS VERIFICATION FORM
FSFA10
