OFFICE OF FINANCIAL AID
AND SCHOLARSHIPS
Check your myClackamas account for all financial aid correspondence and your Award Letter.
Secure submission of documents can be completed in person, by mail, or fax to:
Office of Financial Aid and Scholarships · Roger Rook Hall · 19600 Molalla Avenue, Oregon City, OR 97045
Phone: 503-594-6082 · Fax: 503-722-5864 · e-mail: finaid@clackamas.edu · www.clackamas.edu
02/28/20 Dp
FAC20HYV
2020-2021 UNACCOMPANIED HOMELESS YOUTH VERIFICATION
(Summer Term 2020 – Spring Term 2021)
Student Last Name Student First Name
Student ID# Date of Birth
On the Free Application for Federal Student Aid (FAFSA), you answered “Yes” that you were an
unaccompanied youth who was homeless or were self-supporting and at risk of being homeless.
Homelessness verification may be made by a local Educational Homeless Liaison designated pursuant to the
McKinney-Vento Homeless Assistance Act, the Director (or designee) of a program funded under the
Runaway and Homeless Youth Act, or the Director (or designee) of a program funded under the McKinney-
Vento Homelessness Act (relating to emergency
shelter grants).
I am providing this letter of verification as:
A School District Liaison:_____________________________________________________________
A Director or Designee of a HUD-funded shelter:__________________________________________
A Director or Designee of a RHYA-funded shelter:_________________________________________
I hereby confirm that the above named student was (check one):
An unaccompanied homeless youth after July 1, 2019. (This means that, after July 1, 2019, the student
was living in a homeless situation, as defined by Section 725 of the McKinney-Vento Act.)
An unaccompanied, self-supporting youth at risk of homelessness after July 1, 2019. (This means that,
after July 1, 2019, the above named student was not in the physical custody of a parent or guardian,
provides for his/her own living expenses entirely on his/her own, and is at risk of losing his/her housing.)
Authorized Signature (Please attach your business card)
Date
Print Name Telephone Number
Title
Agency
*************************************FINANCIAL AID OFFICE USE ONLY***********************************
APPROVED
DENIED
_______________________________________________ ___________________________________
Financial Aid Specialist Date
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