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200809274 STUDENT FINANCIAL AID VERIFICATION NWJl968 TO: Name & Address of Financial Aid Provider Phone Number Fax Number RE: Social Security Number Applicant/Tenant Name Unit # (if assigned) o If you are over the age of 23 with dependent child(ren), please check here. o If you are a student residing with your parentIs), please check here. I hereby authorize release of my financial aid information. Signature of Applicant/Tenant Date The individual named directly above is an applicant/tenant ofa housing program that requires verification of income. The information provided will remain confidential and will be used solely for the purpose of determining eligibility for occupancy . Your prompt response is crucial and greatly appreciated. Signature of Owner's Representative Return Form To: The above-named individual has applied for residency or is currently residing in housing that requires verification of student status. Please provide the information requested below. Student currently attends school: (please circle one) Full Time Part Time Total scholarships, grants, gifts etc. (public or private, excluding student loans) received is: Source Spring 20_ Summer 20_ Fall 20 - Scholarships $ $ $ Grants $ $ $ Other Contributions $ $ $ Cost of Tuition $ $ $ Expected Date of Graduation: I hereby certify that the information supplied in this section is true and complete to the best of my knowledge. Signature: Date: Printed Name: Tel. #: Title: Fax#: Educational Institution: E-mail: NOTE: Section 1001 of Title 18 of the U.S. Code makes it a criminal oflense to make willful false statements or misrepresentations to any Department or Agency of the United States as to any matter within its jurisdiction. (Updated 11107)