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201109462 STUDENT FINANCIAL AID VERIFICATION _; °' THIS SECTTON TO"B�'C�MPLET�I?-B'Y TENAN'C AND�EXECUTED BY Iv1AI�TAG�TvMENT �" � °, " , �� ,... , ; �. ,._,. .. :.. � _ , , ,:. TO: Name&Address of Financial Aid Provider Phone Number Fax Number RE: Applicant/Tenant Name Social Security Number Unit#(if assigned) ❑If you are 24 years of age or older with dependent child(ren),please check here. ❑If you are a student residing with your parent(s),who are applying for or receiving Section 8 assistance,please check here. 1 hereby authorize release of my financial aid information. Signature of Applicant/Tenant Date The individual named directly above is an applicandtenant of a 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 Cwner's Representative � Return Form To: . � �_ .� � � ,. ;�T�-IIS SECTTOAi TO.BE CQMF'�E'�ED�BY FINANCIAL;�ID PROUxIDER ANDf,I"�R ET3UCA'I'It)NAL INSTITUTION'�` ,,... � � < ��>� �..�, ,_ ��,.,. .. 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, e.ecluding student loans) receiveri 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: vOTE: Section 1001 of Tide I S of the U.S.Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of the United States as to any matter within its jurisdiction. (Updated 12/10)