Cal Grant Gpa Verification Form - California Student Aid Commission Page 2
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1
2Instructions for filling out the Cal Grant GPA Verification Form
STUDENT INFORMATION SECTION. Please print clearly using blue or black ink only. Filing deadline for 2017-18 awards is March 2, 2017
1. Your Social Security number or DREAM Act ID Number: Enter your Social Security number (SSN) as it appears on your Social
Security card and your FAFSA. (Valid SSNs do not begin with 9 or 000. If you believe your SSN begins with a 9 or 000, then
contact your local Social Security Office to verify your number.) Individual Tax Identification Numbers (ITIN) are not accepted. If
you are a Dream Act Applicant and do not have a valid SSN, please enter your DREAM Act ID number which was given to you
when you completed your Dream Act Application.
2. Month/year of high school graduation: Enter the month and year you graduated, or plan to graduate from high school. Enter
the month in a two-digit format (for example: January should be appear as “01”; November should appear as “11”). Enter the
year in a four-digit format (for example: 2015 should appear as “2015”).
3. Your name: Print your full name as it appears on your Social Security card. Enter last name, first name, middle initial.
4. Your date of birth: Enter your birth date. For example, June 25, 1999 would be entered as 06-25-1999.
5. Telephone number: Enter your area code and daytime telephone number.
6. Your permanent mailing address: Enter your permanent mailing address, city, state and five-digit zip code.
7. Your E-mail address: Enter a “safe” e-mail address where you can be contacted for questions. This is optional.
8. Submitting a test score instead of a GPA: Complete questions 1 through 9, sign the form and attach a photo copy of the testing
organization’s score report and mail by the deadline to Commission. DIPLOMAS WILL NOT BE PROCESSED.
The results from the GED, SAT, ACT, TASC or HiSET tests must be submitted in lieu of a GPA if:
n You participated in a home schooling program or attended an unaccredited high school.
n You attended a high school or college outside of the United States and are unable to have those grades converted to a 4.00
scale or your school did not grade in a manner that can be readily converted to a 4.00 scale.
n Students who have been out of school for five years can choose to submit either test scores or their GPA.
– Scores from the California High School Proficiency Examination (CHSPE) cannot be accepted in lieu of a high school
GPA, but passing the CHSPE does meet the high school graduation requirement of the Entitlement Cal Grant
program. Also, grade reports, transcripts, and other proficiency certificates WILL NOT BE ACCEPTED.
– Only scores from the SAT reasoning test WILL BE ACCEPTED. Subject test scores will NOT BE PROCESSED.
9. Student signature: By signing this form, you certify that you have read these instructions and that the information you provided
is correct. It is illegal to report false or misleading information on this form and doing so may result in any Cal Grant award
being revoked.
Once you have filled out the student information, take the form to your school and request that they verify your GPA. Be aware
that if your school will be electronically submitting your GPA to the California Student Aid Commission, you do not need to
submit this form. It is your responsibility to verify that the school will be submitting your GPA for you.
FOR SCHOOL USE ONLY SECTION
STATE STUDENT IDENTIFICATION NUMBER:
(Optional) Please enter the 10-Digit Statewide Student Identification Number (SSID) of the
student who’s GPA is listed on this form. If the student does NOT have a SSID, please leave
blank.
Fill in this bubble ONLY if the GPA is based on high school coursework.
GPA IS BASED ON HIGH SCHOOL COURSEWORK:
Fill in this bubble ONLY if the GPA being certified is based on at least 16 but less than
CA COMMUNITY COLLEGE RE-ESTABLISHED GPA:
24 units completed at a California Community College. If the GPA is based on col-
lege units, and is not a reestablished GPA as described above, do not fill in any bubble.
High schools use their College Board school code; colleges use their USED OPE ID code.
GPA VERIFIER’S SCHOOL CODE:
Fill in ALL three GPA spaces. Cal Grant GPAs are calculated on a 4.00 scale. High Schools certifying
VERIFIED STUDENT GPA:
GPAs MUST be accredited or have a UC approved course list in order to verify GPAs. Students not
attending accredited high schools should provide either a GED, SAT, ACT, TASC or HiSET score.
After the school completes the GPA information, we recommend making a copy for your records, and purchas-
ing a $1.30 Certificate of Mailing from the post office and mail to:
California Student Aid Commission
Cal Grant Operations
P.O. Box 419077
Rancho Cordova, CA 95741-9077
G-4 (6/16)
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