2015-2016 UNACCOMPANIED/HOMELESS YOUTH
VERIFICATION FORM
The Free Application for Federal Student Aid (FAFSA) stipulates that a student 21 years of age or younger may be considered independent for financial aid
purposes if they have received a determination at any time on or after July 1, 2014 that they were an unaccompanied youth who was homeless or at risk
of being homeless. If you answered yes to this question this form is required as documentation of your status. Please complete and return to the VCU Office
of Financial Aid.
NAME ________________________________________________________________________
Last
First
MI
Student ID Number
ADDRESS _________________________________________________________________________________________________________
Street Address
Apt. #
City
State
Zip Code
DATE OF BIRTH ______________________________________________ EMAIL ADDRESS _________________________________________
HOME PHONE NUMBER ________________________________________ ALTERNATE/CELL-PHONE NUMBER ____________________________
(Including area code)
(Including area code)
I am providing this letter of verification as a (check one):
A McKinney-Vento School District Liaison
A director or designee of a HUD-funded shelter _________________________________________
A director or designee of a RHYA-funded shelter ________________________________________
As per the College Cost Reduction and Access Act (Public Law 110-84), I am authorized to verify this student’s living situation. Should you have additional
questions or need more information about this student, please contact me at the number listed below.
This letter is to confirm that ___________________________________________________________ was:
Student Name
an unaccompanied homeless youth on or after July 1, 2014.
This means that, on or after July 1, 2014 ________________________________________ was living in a homeless situation, as defined
by Section 725 of the McKinney-Vento Act, and was not in the physical custody of a parent or guardian.
OR
an unaccompanied, self-supporting youth at risk of homelessness on or after July 1, 2014.
This means that, on or after July 1, 2014, _______________________________________ 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 _____________________________________________ DATE ____________________________________________
PRINT NAME ______________________________________________________ WORK PHONE NUMBER ______________________________
TITLE ____________________________________________________________ AGENCY __________________________________________
Office of Financial Aid
Grace E. Harris Hall Student Service Center
1015 Floyd Ave., 1st Floor
P.O. Box 843026
Richmond, VA 23284-2520
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(804) 828-1550
Fax (804) 827-0060
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VCU is an EEO/AA institution. ENR1314-121