2015-2016 Aggregate Verification Worksheet ((F16VG5)

2015-2016 Aggregate Verification Worksheet ((F16VG5)

2015-2016 Aggregate Verification Worksheet ((F16VG5)
Your Free Application for Federal Student Aid (FAFSA) application has been selected for a process called verification.
Your financial aid award cannot be finalized, nor will funds be disbursed until verification is complete.
A. STUDENT INFORMATION (please print clearly)
___________________
_______________
______
______________________
Last name
First name
M.I.
LTC Student ID #
_____________________________________________________________ ________________________
Address (include apt. no.)
Date of birth
________________________________ __________ _________ ________________________________
City
State
ZIP code
Phone number (include area code)
B. HIGH SCHOOL COMPLETION STATUS
Provide one of the following documents that indicates the student’s high school completion status when the student will
begin college in 2015-2016:
 A copy of the student’s high school diploma
 A copy of the student’s final official high school transcript that shows the date when the diploma was awarded.
 A copy of the student’s General Educational Development (GED) certificate, an official GED transcript that indicates
the student passed the exam, or a state-authorized high school equivalent certificate.
 For students who completed secondary education in a foreign country, a copy of the “secondary school leaving
certificate” or other similar document.
 An academic transcript that indicates the student successfully completed at least a two-year program that is acceptable
for full credit toward a bachelor’s degree
 For a homeschooled student from a state where state law requires the student to obtain a secondary school completion
credential for homeschool (other than a high school diploma or its recognized equivalent), a copy of that credential.
 For a homeschooled student from a state where state law does not require the student to obtain a secondary school
completion credential for homeschool (other than a high school diploma or its recognized equivalent), a transcript
or the equivalent, signed by the student's parent or guardian, that lists the secondary school courses the student
completed and includes a statement that the student successfully completed a secondary school education in a
homeschool setting.
A student who is unable to obtain the documentation listed above must contact the financial aid office.
C. VERIFICATION OF INCOME
A student who has been selected for aggregate verification also must submit other income-related verification items.
Please refer to your To Do list on your MyLTC for further forms and related items.
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D. IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE (to be signed at LTC)
The student must appear in person at Lakeshore Technical College to verify his or her identity by presenting a valid
government-issued photo identification (ID), such as, but not limited to, a driver’s license, other state-issued ID, or passport.
The institution will maintain a copy of the student’s photo ID that is annotated by the institution with the date it was received
and reviewed and the name of the official at the institution authorized to collect the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose provided
below:
Statement of Educational Purpose
I certify that I, DO NOT COMPLETE UNTIL PRESENT IN THE FINANCIAL AID OFFICE (student’s printed name),
am the individual signing this Statement of Educational Purpose and that the Federal student financial assistance I may
receive will only be used for educational purposes and to pay the cost of attending Lakeshore Technical College for 20152016.
Student Signature (required) DO NOT SIGN UNTIL PRESENT IN THE FINANCIAL AID OFFICE
Date ________________
Student’s ID Number _____________________________________________
Declaración de Propósito Educativo
Certifico que yo, __________________________ (Imprimir Nombre del Estudiante) soy el
individuo que firma esta Declaración de Finalidad Educativa y que la ayuda financiera federal
estudiantil que yo pueda recibir, sólo será utilizada para fines educativos y para pagar el costo de
asistir a Lakeshore Technical College para 2015–2016.
_ DO NOT SIGN UNTIL PRESENT IN THE FINANCIAL AID OFFICE
Firma del Estudiante
la Fecha________________________________
Número de Identificación del Estudiante _________________________________
LTC Financial Aid Staff Member’s Signature & Date
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***If the student is unable to appear in person at Lakeshore Technical College to verify his or her identity, the student
must provide:
(a) A copy of the valid government-issued photo identification (ID) that is acknowledged in the notary statement below,
such as, but not limited to a driver’s license, other state-issued ID, or passport; and
(b) The original Statement of Educational Purpose, which is provided below, must be notarized. If the notary statement
appears on a separate page than the Statement of Educational Purpose, there must be a clear indication that the
Statement of Educational Purpose was the document notarized.
Statement of Educational Purpose
I certify that I, DO NOT COMPLETE UNTIL PRESENT IN THE FINANCIAL AID OFFICE (student’s printed name),
am the individual signing this Statement of Educational Purpose and that the Federal student financial assistance I may
receive will only be used for educational purposes and to pay the cost of attending Lakeshore Technical College for 20152016.
Student Signature (required) DO NOT SIGN UNTIL PRESENT IN THE FINANCIAL AID OFFICE
Date ________________
Student’s ID Number _____________________________________________
Declaración de Propósito Educativo
Certifico que yo, __________________________ (Imprimir Nombre del Estudiante) soy el
individuo que firma esta Declaración de Finalidad Educativa y que la ayuda financiera federal
estudiantil que yo pueda recibir, sólo será utilizada para fines educativos y para pagar el costo de
asistir a Lakeshore Technical College para 2015–2016.
_ DO NOT SIGN UNTIL PRESENT IN THE FINANCIAL AID OFFICE
Firma del Estudiante
la Fecha________________________________
Número de Identificación del Estudiante _________________________________
Notary’s Certificate of Acknowledgement
State of _____________________________________________________________________
City/County of ________________________________________________________________
On_____________________, before me, __________________________________________,
(Date)
(Notary’s name)
personally appeared, __________________________________________, and proved to me
(Printed name of signer)
on basis of satisfactory evidence of identification______________________________________
(Type of government-issued photo ID provided)
to be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal
(seal)
________________________________________
(Notary signature)
My commission expires on _________________________
(Date)
**************************************************************************************************
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E. SIGN THE WORKSHEET
Certification and Signature
Certification and Signature
Each person signing below certifies that all of the
information reported is complete and correct.
WARNING: If you purposely give false or
misleading information you may be fined,
be sentenced to jail, or both.
________________________________________
Print Student’s Name
________________________
Student’s ID Number
________________________________________
Student’s Signature (Required)
________________________
Date
________________________________________
Spouse’s Signature (Optional)
________________________
Date
________________________________________
Print Parent’s Name
________________________
Date
________________________________________
Parent’s Signature
________________________
Date
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