Unaccompanied Homeless Youth Verification For The Purpose Of Federal Financial Aid Form

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PLACE ON AGENCY LETER HEAD
Unaccompanied Homeless Youth Verification
For the Purpose of Federal financial Aid
Re: ______________________________________ (Name of Student)
DOB______________________________________
Current Mailing Address of Student (if none, please list name, phone number, and mailing address of current
contact:________________________________________________________________________
_____________________________________________________________________________________
I am providing this letter of verification as a (check one):
___ A McKinney-Vento School District Liaison
___ A director or designee of HUD-funded shelter: _____________________________________
___ A director or designee of a RHYA-funded shelter: ____________________________________
___ A financial aid administrator: ____________________________________________________
As per the College Cost Reduction and Access Act (Public Law 110-84), I am authorized to verify this student’s living
situation. No further verification by the Financial Aid Administrator is necessary. Should you have additional
questions or need more information about this, please contact me at the number listed above.
This letter is to confirm that: ________________________________________________was:
(NAME OF STUDENT)
Check one:
____ An unaccompanied, self-supporting youth at risk of homelessness after July1, 2014.
This means that, after July 1, 2014, _______________________ (name of Student) 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.
____ An unaccompanied, self-supporting youth at risk of homelessness after July 1, 2014.
This means that, after July 1, 2014 ________________________ (name of student) was not in the physical custody
of a parent or guardian, provides for his/her own living expense entirely on his/her own, and is at risk of losing
his/her housing.
Authorized signature _____________________________________
Date __________________________
Print Name_____________________________________________ Telephone Number _____________________
Title ________________________________________________________________________________________
Agency_______________________________________________________________________________________

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