Fillable Student Dislocated Worker 18 (University of Central Missouri)

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Student Dislocated Worker 18 (University of Central Missouri)

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University of Central Missouri
Office of Student Financial Services
P.O. Box 800
Warrensburg, MO 64093-5178
PH 660-543-8266 FAX 660-543-8080
Webpage: www.ucmo.edu/sfs
Dislocated Worker
Worksheet - Student -
2018/2019
UCM use only
DSLS17
___________________________________________________ 700___________________________
Student’s Name (please print) UCM ID Number
On your 2018/2019 Free Application for Federal Student Aid (FAFSA), you indicated that you (or your spouse, if
married) is classified as a Dislocated Worker. This status can impact your eligibility for federal financial
assistance and must be verified. Please respond to each of the following items, sign and date below, and return
this document to the UCM Office of Student Financial Services.
Yes
No
I/my spouse recently lost a full-time job on _________________________________.
Yes
No
I/my spouse have recently been laid off (or have received a lay-off notice) from
a full-time job on ______________________________________________________.
Yes
No
I am/my spouse is receiving unemployment benefits due to having lost a full- time
job or having been laid off from a full-time job on ___________________________.
Yes
No
I/my spouse will not likely return to my/my spouse’s previous position of employment.
Yes
No
I/my spouse was self-employed but am currently unemployed due to economic
circumstances (or a natural disaster).
Yes
No
I/my spouse am a ‘displaced homemaker’ because I/my spouse was previously a stay-at-
home mother/father, am no longer supported by my spouse, and am currently unemployed
or underemployed, and am having trouble finding or upgrading employment
Yes
I/my spouse have/has experienced a loss of employment because of my relocation due to an
active duty permanent change of duty station.
Yes
I/my spouse am/is unemployed or underemployed and is experiencing difficulty in obtaining
or upgrading employment because of my relocation due to an active duty permanent change
of duty station.
For any item above which you answered Yes, provide a detailed explanation below regarding why you
answered Yes. (Continue on an additional page, if necessary.)
Mark this box if you actually should have answered No to the Dislocated Worker question
on your 2018/2019 FAFSA.
___________________________________________________ ______________________________
Student’s Signature Date
___________________________________________________ ______________________________
Spouse’s Signature (if student is married) Date
C
omplete and submit this document to the UCM Office of Student Financial Services in person (1100 Ward Edwards Bldg.) or by mail
(University of Central Missouri, Student Financial Services, P.O. Box 800, 1100 Ward Edwards Bldg., Warrensburg MO 64093-5178), or by fax
(660-543-8080).
Student_Dislocated_Worker_18.pdf NOV 30, 2017
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Student Dislocated Worker 18 (University of Central Missouri)

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Completed 23 July 2020

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