Homeless Verification Form

  A. Student Infomation







  B. Homelessness Infomation

According to the information we received from the Federal Processing Center, you answered “Yes” to one or more of the following questions on the Free Application for Federal Student Aid (FAFSA):

  • At any time on or after July 1, 2013, did your high school or school district homeless liaison determine that you were an unaccompanied youth who was homeless? (Q55)

      -- If this is the case, you will need to submit a letter of confirmation from your high school representative (Principle, Guidance Counselor, Social Worker, etc) which acknowledges your circumstance. The letter must be on the School’s Letterhead.

  • At any time on or after July 1, 2013, did the director of an emergency shelter or transitional housing program funded by the U.S. Department of Housing and Urban Development determine that you were an unaccompanied youth who was homeless? (Q56)

      -- If this is the case, you will need to submit a letter of confirmation from FEMA, a homeless shelter, or other homeless facility or Social Worker which acknowledges your circumstance. The letter must be on the agency’s letterhead.

  • At any time on or after July 1, 2013, did the Director of a runaway or homeless youth basic center or transitional living program determine that you were an unaccompanied youth who was homeless or were self-supporting and at risk of being homeless? (Q57)

     -- If this is the case, you will need to submit a letter of confirmation from a homeless shelter, or other homeless/temporary living facility or Social Worker which acknowledges your circumstance. The letter must be on the agency’s letterhead.


If you have another living condition that is not described above, please check the box below.


  C. Certification Section



Enter your first and last name



Enter the date you are submitting this form


By checking the box below, you certify and acknowledge that the information you have provided on this form and your FAFSA is complete and correct.



Warning: If you purposely give false or misleading information on this form, you may receive disciplinary action, penalties and/or denial of financial aid.

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