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200809274 20vaW68 ANNUAL STUDENT CERTIFICATION Effective Date: Move-in Date: (MMIDD/YYYY) This Annual Student Certification is being delivered in connection with the undersigned's application/occupancy in the following apartment: Head of Household Name: Unit Number: Building Address: Check A, B, or C, as applicable (note that "student" includes those attending public or private elementary schools, middle or junior high schools, senior high schools, colleges universities, technical, trade, or mechanical schools, but does not include those attending on-the-job training courses): A. Household contains at least one occupant who is not a student and has not been/will not be a student for five or more months out of the current and/or upcoming calendar year (months need not be consecutive). If this item is checked, no further information is needed. Sign and date below. B. Household contains all students, but is qualified because the following occupant(s) is/are a PART TIME student(s). Verification of part time student status is required for at least one occupant. C. Household contains all FULL TIME students for five or more months out of the current and/or upcoming calendar year (months need not be consecutive). If this item is checked, questions 1-4, below must be completed: 1. Are the students married and entitled to file a joint tax return? (attach marriage certificate YES NO or tax return) 2. Does the household consist of single-parent(s) with child(ren) and neither the parent(s) YES NO nor child(ren) are claimed as dependents on another's tax return? (attach student's most recent tax return or Certification of Dependent Child(ren)) 3. Is at least one student receiving Temporary Assistance to Needy Families (TANF), YES NO formally known as Aid to Families with Dependant Children (AFDC) (provide third party verification) 4. Docs at least one student participate in a program receiving assistance under the Job YES NO Training Partnership Act, Workforce Investment Act, or under other similar, federal, state or local laws? (attach verification of participation) Full-time student household~ that are income eligible and satisfy one or more of the above conditions are considered eligible. 1fquestions 1-4 are marked NO, or verification does not support the exception indicated, the household is considered an ineligible student household. Under penalty of perjury, l/we certify that the information presented in this certification is true and accurate to the best of my knowledge. The undersigned further understand(s) that providing false representation herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination of a lease agreement. All household members age 18 or older must sign and date. Signature (Date) Signature (Date) Signature (Date) Signanlre (Date) (Updated 11/07)