:
:
VWI4O
2020-2021 Verification Worksheet Form 4
Student ID Number
Student Name
Phone Number
Form must be completed in blue or black ink. Failure to accurately complete this form may result in a
delay of processing or change of financial aid eligibility. Additional documentation may be requested.
Read instructions carefully before completing.
Section 1: High School Completion Status
Please submit documentation to verify you have completed a high school education. Acceptable
documentation can include:
A high school diploma or a copy of an official high school transcript. Transcripts must verify graduation
completion date
GED certificate or transcript
A transcript that indicates that you have successfully completed at least a two-year program that is acceptable
for full credit toward a bachelors degree at any participating school
Home school credential or transcript
If high school completed in foreign country, a copy of the secondary school leaving certificate” or similar
document
Type of documentation submitted:
Designated institutional official:
Section 2: Identity
MUST BE COMPLETED & SIGNED AT THE FINANCIAL AID OFFICE
If unable to appear in person at the Financial Aid Office, you must complete this section with anotary
You must appear in person at Financial Aid Office to verify your
(Name of ins titution)
identity by presenting a valid unexpired 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 your photo ID.
Type of documentation submitted:
Designated institutional official:
Page 1 of 2
VWI4O
Student ID Number: S
Section 3: Statement of Educational Purpose
MUST BE COMPLETED & SIGNED AT THE FINANCIAL AID OFFICE
If unable to appear in person at the Financial Aid Office, you must complete this section with a notary
In addition, you must sign, in the presence of the institutional official, the following:
I certify that I am the individual signing this
(Student’s printed name)
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
for 2020-2021.
(Name of ins titution)
Student Signature: Date:
Notary Section Instructions: Please Read
This section should only be completed if you are unable to appear in person at the institution with a designated official.
This form (the original on which the seal is visible) should be mailed to the Financial Aid Office at your institution along
with the copy of the government-issued identification and high school documentation.
Notary’s Certificate of Acknowledgement
State of City/County of
On
, before me
(Date) (Notarys name)
Personally
appeared and proved to me on the basis of
(Printed name of signer)
Sati sfactory evidence
of Identification to be the above-named
(Type of unexpired government-issued ID provided)
Person who signed the foregoing instrument.
My commi s sion expires on , 20
Notary (Print):
Notary (Signature):
(Seal)
Page 2 of 2
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome