202 S. Halsted St.
Chicago Heights, IL 60411
Financial Aid Office
Fax: (708) 709-3716
2014-15 Unaccompanied Homeless Youth Verification Form
Student’s Printed Name Student ID#
You reported on your Free Application for Federal Student Aid (FAFSA) that you are an unaccompanied youth who
is homeless, or are an unaccompanied youth providing for your own living expenses who is at risk of being
homeless. We must have this completed form and any required documentation before we can continue processing
your financial aid.
Remember to include your student ID number on all documentation submitted.
Attach Documentation Verifying Homelessness or Risk of Homelessness
Attach documentation from one of the following:
A McKinney-Vento School District Liaison
A director or designee of a HUD-funded shelter
A director or designee of a RHYA-funded shelter
The documentation must confirm:
You are an unaccompanied homeless youth – This means that, after July 1, 2013, you are living
in a homeless situation, as defined by Section 725 of the McKinney-Vento Act, and are not in the
physical custody of a parent or guardian,
You are an unaccompanied, self-supporting youth at risk of homelessness – This means that,
after July 1, 2013, you are not in the physical custody of a parent/guardian, you provide your
own living expenses entirely, and are at risk of losing your housing.
Attach an explanation letter if you cannot obtain a letter from one of the above
Attach a letter explaining your situation, if you have other circumstances that qualify you as an
unaccompanied homeless youth or are at risk of homelessness and are not able to get documentation from
one of the above officials. The National Center for Homeless Education 1-800-308-2145 if also available if you
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. Also, if you are living in any of these situations
and fleeing an abusive parent you may be considered homeless even if your parent would provide support and a place to
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 still enrolled in high school as of the day you sign your FAFSA.
Check, if you are not homeless and will provide parental information on the FAFSA
I am not homeless and do not qualify as an unaccompanied homeless youth or youth at risk of homelessness.
You must correct the information on your FAFSA by providing your parent(s) financial
You and one parent must sign the FAFSA and submit it to the federal processor.
I declare, under penalty of perjury, that the information on this form is true, complete, and accurate to the best of
Student’s Signature__________________________________ Date__________________________