Fill - Free fillable Form 5307497999: FinancialAidOffices 20202021UnaccompaniedHomelessYouthDeterminationForm (Woodland Community College) PDF form

YubaCommunityCollegeDistrict

FinancialAidOffices



YubaCollege

2088NorthBealeRoad

Marysville,CA95901

530‐749‐7999



WoodlandCommunityCollege

2300EastGibsonRoad

Woodland,CA95776

530‐661‐5725



LakeCounty Campus

15880DamRoadExtension

Clearlake,CA95422

707‐995‐7923



2020‐2021UnaccompaniedHomelessYouthDeterminationForm



Youindicatedonyour2020‐2021FAFSAthatyouwereanunaccompaniedyouthwhowashomeless,orwere

self‐supportingandatriskofbeinghomelessatanytimeonorafterJuly1,2018.Submitthisformalongwith

requireddocumentationtotheFinancialAidOffice.

 “Homeless”meanslackingfixed,regularandadequatehousing,whichincludeslivinginshelters,motelsorcars,

ortemporarilylivingwithotherpeoplebecauseyouhadnowhereelsetogo.

 “Unaccompanied”meansyouarenotlivinginthephysicalcustodyofyourparentorguardian.

 “Youth”meansyou

are21yearsofageoryoungeroryouwerestillenrolledinhighschoolasofthedayyou

signedyour2020‐2021FAFSA.

 “Self‐supporting”meansyoupayforyourownlivingexpenses,includingfixed,regular,andadequatehousing.



DOCUMENTATIONREQUIRED‐SubmitdocumentationtotheFinancialAidOffice

 2020‐2021UnaccompaniedHomelessYouthDeterminationForm

 PersonalStatement(RefertoQuestion3below)

 Affidavit

STUDENTINFORMATION–Tobecompletedbythestudent

_______________________________________________________ _______________________________

FirstMI Last  SocialSecurity#



_______________________________________________________ _______________________________

MailingAddressDateofBirth



_______________________________________________________ _______________________________

City    State  ZipCode PhoneNumber



1.Areyou21yearsofageoryounger?YesNo

2.Whatisyourcurrentlivingsituation?Checktheboxthatapplies.

Livewithparents Liveoffcampus(Ipaymyownrent/housing)

Livewithfamily(statewhoyoulivewith):______________________________________________________

Livewithfriends(statewhoyoulivewith):_____________________________________________________

Other(Pleaseexplain):_____________________________________________________________________

3.Attachatypedstatement(letter)thatexplainsyourhomelesssituation.Includethefollowinginformation

ontheletter:

 Yourname,studentIDandsignature

 Explainindetailhowyouhappentobehomeless

 Howlongyouexpectyoursituationtoremainthesame

 Datesyouhave

beenhomeless

 Thenatureofyourrelationshipwithyourparents

 Whyyoucannotobtaininformationand/orsupportfromyourparents



Page1 UnaccompaniedHomelessYouth









4.Whenisthelasttimeyou:

a)livedwithyour  Father_________________ Mother_________________

b)receivedsupportfromyou Father_________________ Mother_________________

c)hadanycontactwithyour Father_________________ Mother_________________

5.Astudentisself‐supportingwhenhepaysforhisownlivingexpenses(food,

groceries,utilities),including

fixed,regular,andadequatehousing.Areyouself‐supporting?YesNo

Ifyes,explainhowyousupportyourself.______________________________________________________

________________________________________________________________________________________



SIGNANDDATE

Icertifythattheinformationprovidedonthisformandanyattachmentsistrueandcorrecttothebestofmyknowledge.Iunderstand

that this information will be used to determine my eligibility and that false or misleading information may be cause for denial,

termination,and/orrepaymentoffinancialaid

funds.



____________________________________________________________ ______________________________________________

StudentSignatureDate



FORFINANCIALAIDOFFICEUSEONLY



 Approved‐UnaccompaniedhomelessyouthafterJuly1,2018

 Approved‐Unaccompanied,self‐supportingyouthatriskofhomelessnessafterJuly1,2018

 Denied:_________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

_____________________________________________________ _________________________________



FinancialAidSignature Date



Page2 UnaccompaniedHomelessYouth

Rev.9/25/17



YubaCommunityCollegeDistrict–FinancialAid

2020‐2021UnaccompaniedHomelessYouthDeterminationAffidavit



_________________________________________________ ____________________________

Student'sNameStudentID#



This form is tobe completed by athird party who is familiar with your situation and has known you for a minimum of

three years, such a, a high school or college counselor, social services agency official, pastor orclergy member, mental

health professional, law enforcement officer, or teacher.

Affidavits from other students and/or friends are not

consideredanindependentthirdparty.



Thestudentnamedabovehasindicatedontheapplicationforfinancialaidthathe/sheisunabletoprovideparent

informationduetounusualcircumstances.Pleaseanswerthefollowingquestions:



1.Howlonghaveyouknownthestudent?

_______________________________________________________________

2.Inwhatcapacity?_________________________________________________________________________________

3.Provideabriefstatementexplainingthecircumstancesthatleadthestudenttobehomeless.Includewherethe

studentiscurrentlyliving.

________________________________________________________________________________________________

________________________________________________________________________________________________

4.Provideabriefstatementregardingyourknowledgeofthestudent'sfamilyhistoryandtheirrelationshipwiththeir



parent(s).

________________________________________________________________________________________________

________________________________________________________________________________________________

5.Whatisthelastdatethestudent:

a.Receivedfinancialsupportfromparents?_____________________________________

b.Livedwithparents?   _____________________________________

6.Howisthestudentcurrentlysupportinghimself/herself?_________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Icertifythattheinformationprovidedonthisformandanyattachmentsistrueandcorrecttothebestofmyknowledge.

AuthorizedSignature Date

PrintName TelephoneNumber

Agency Title



Page3 UnaccompaniedHomelessYouth



Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

Form 5307497999: FinancialAidOffices 20202021UnaccompaniedHomelessYouthDeterminationForm (Woodland Community College)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Form 5307497999: FinancialAidOffices 20202021UnaccompaniedHomelessYouthDeterminationForm (Woodland Community College) Form

Related forms

Fillable Form 5307497999: FinancialAidOffices 20202021UnaccompaniedHomelessYouthDeterminationForm (Woodland Community College)

Fill Online, Printable, Fillable, Blank Form 5307497999: FinancialAidOffices 20202021UnaccompaniedHomelessYouthDeterminationForm (Woodland Community College) Form

Related forms

First 20 documents completely FREE!