Benton Harbor, MI 49022
Phone: 269-927-8112/ Fax: 269-927-8183
Unaccompanied Homeless Youth Verification Form
Student ID Number:
When you completed your 2020-2021 Free Application for Federal Student Aid (FAFSA), you answered yes to
one of the unaccompained homeless youth questions. Please complete this verification form and submit to the
Financial Aid Office with certification from the appropriate agency verifying your homeless status.
• Homeless means lacking fixed, regular and adequate housing, which includes living in shelters, motels,
cars, or temporarily living with other people.
• Unaccompanied means you are not living in the physical custody of your parent or guardian.
• Youth means you are 21 years or younger or you are still enrolled in high school as of the day you signed
1. If you check one of the three boxes below, you must provide documentation by submitting page 3 of this
Unaccompanied Youth who was homeless determined by high school or school district homeless liaison
Unaccompained Youth who was homeless determined by HUD ( U.S. Dept. of Housing & Urban
Unaccompained Youth was was homeless and at risk of being homeless determined by homeless youth
basic center or transitional living program
2. If you living situation cannot be verified by the above agencies, does your living situation meet the following
• I am homeless meaning lacking, regular or adequate housing, which includes living in shelters,
motels, cars, or temporarily living with other people “couch surfing”.
If you answered “Yes” to question #2, you must submit a letter, a detailed statement of your current
living situation along with this form.