Verify Last Date Of Attendance Form - University Scholarships & Financial Aid Services(Usfas)
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1Verify Last Date of Attendance
Student’s Name: ______________________________________________________________________________________________________________________________________
U
USF ID:
_____ _____ _____ _____ _____ _____ _____ _____
Date of Birth: _____ _____ / _____ _____ / _____ _____ _____ _____
Month
Day
Year
Students who receive all unsatisfactory grades (that is; F, U, I, M) for a term are considered an unofficial withdrawal. A
last date of attendance may be reported on the grade sheet submitted by an instructor to the Office of the Registrar for
each course. You may request the instructor who taught the last course you attended for that term to document your last
date of attendance. Undocumented dates cannot be used. Both you and the instructor need to sign, date and return this
form with the required information to the office of University Scholarships & Financial Aid Services. You will be notified
regarding the results of our review.
CERTIFICATION STATEMENT
By signing this form, I certify that all the information reported to qualify for federal student aid is complete and correct.
Student’s Signature: ____________________________________________________________ Date: ______ / ______ / ______
Required
(mm/dd/yy)
WARNING: If you purposely give false or misleading information on this worksheet,
you may be fined, sentenced to jail, or both.
To be completed by the Instructor/Academic Department Chair only:
The last date of attendance is defined as the last date a documented academic related activity was completed by the
student for the course listed below during the USF class schedule dates. A documented academic related activity may
include, but is not limited to: class attendance, submission of assignments, taking exams, lab work, etc. Note: For online
courses, logging into a student’s account does not meet the requirements of an academic related activity. This form will be
forwarded to the Office of the Registrar to override the last date of attendance on the grade sheet.
Term
Subj/Crse/Sec#
Last Date Attended
Department/College Stamp - Required
(Ex. Fall 2015)
_________________
_________________________
_____ / _____ / _____
(mm/dd/yy)
Instructor/Department Chair’s Name: __________________________________________________________________________
Print
Title: _______________________________________________________________________________________________________
Department: ________________________________________________________________________________________________
WARNING: In the event of a Federal audit, you may be asked to provide documentation (e.g. grade book entry,
copy of exam, etc.) to support the last date of attendance reported.
Instructor/Department Chair’s Signature: _________________________________________ Date: ______ / ______ / ______
Required
(mm/dd/yy)
Phone Number: (__________) __________ - ___________ E-mail Address: __________________________________________
USFAS
4202 E. Fowler Ave., SVC 1102
Tampa, Florida 33620-6960
(813) 974-4700 ·
University Scholarships
& Financial Aid Services
1516_vlda · mah · 10-28-15/sb · Page 1 of 1
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