"Student Status and Financial Aid Verification" - New York

Student Status and Financial Aid Verification is a legal document that was released by the New York State Homes and Community Renewal - a government authority operating within New York.

Form Details:

  • Released on January 1, 2019;
  • The latest edition currently provided by the New York State Homes and Community Renewal;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the New York State Homes and Community Renewal.

ADVERTISEMENT
ADVERTISEMENT

Download "Student Status and Financial Aid Verification" - New York

450 times
Rate (4.6 / 5) 23 votes
STUDENT STATUS AND FINANCIAL AID VERIFICATION
TO:
RE:
(Name & Address of Educational Institution)
Applicant/Tenant Name
Student ID Number (if applicable):
Unit Number (if assigned)
FROM:
(Name & Address of Owner/Management Agent)
Contact
at (
)
.
or by email at
if you have any questions
Thank you for your prompt response. All information is confidential.
I hereby authorize the release of the requested information. Information obtained under this consent is limited to information
that is no older than 12 months. There are circumstances which would require the owner to verify information that is up to
five years old, which would be authorized by me on a separate consent, attached to a copy of this consent. (NOTE: You do
not have to sign this form if either the requesting organization or the organization supplying the information is left blank.)
Signature of Applicant/Tenant
Date
THIS SECTION TO BE COMPLETED BY FINANCIAL AID PROVIDER AND/OR EDUCATIONAL INSTITUTION
Please complete all information requested below. Write N/A if not applicable.
1.
Student currently attends school (please circle one):
Full Time
Part Time
Not Currently Enrolled
2.
If full time, the date the student enrolled as such:
_____/_____/_____
3.
Expected date of graduation:
_____/_____/_____
4.
Does student attend summer session?
Yes
No
5.
Is student a participant in a program funded under the Workforce Innovation and Opportunity Act
or a similar program?
Yes
No
6.
Total cost of tuition and required fees (do not include room and board)
$______________
7.
Total financial assistance including scholarships, grants, etc. per semester (public or private, excluding student loans):
Source
Amount
Beginning Date
Ending Date
Scholarships
$
Grants
$
Work Study
$
I hereby certify that the statements above are true and complete to the best of my knowledge.
Signature
Date
Print Name
Title
Address
Email Address
City, State Zip
Phone
Penalties for Misusing This Content: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures
or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any
person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and
fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be
appropriate, against the officer or employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security
number are contained in the Social Security Act at 208 (a) (6), (7), and (8). Violations of these provisions are cited as violations of 42 USC 408 (a), (6), (7), and (8).
Student Status and Financial Aid Verification (2019)
STUDENT STATUS AND FINANCIAL AID VERIFICATION
TO:
RE:
(Name & Address of Educational Institution)
Applicant/Tenant Name
Student ID Number (if applicable):
Unit Number (if assigned)
FROM:
(Name & Address of Owner/Management Agent)
Contact
at (
)
.
or by email at
if you have any questions
Thank you for your prompt response. All information is confidential.
I hereby authorize the release of the requested information. Information obtained under this consent is limited to information
that is no older than 12 months. There are circumstances which would require the owner to verify information that is up to
five years old, which would be authorized by me on a separate consent, attached to a copy of this consent. (NOTE: You do
not have to sign this form if either the requesting organization or the organization supplying the information is left blank.)
Signature of Applicant/Tenant
Date
THIS SECTION TO BE COMPLETED BY FINANCIAL AID PROVIDER AND/OR EDUCATIONAL INSTITUTION
Please complete all information requested below. Write N/A if not applicable.
1.
Student currently attends school (please circle one):
Full Time
Part Time
Not Currently Enrolled
2.
If full time, the date the student enrolled as such:
_____/_____/_____
3.
Expected date of graduation:
_____/_____/_____
4.
Does student attend summer session?
Yes
No
5.
Is student a participant in a program funded under the Workforce Innovation and Opportunity Act
or a similar program?
Yes
No
6.
Total cost of tuition and required fees (do not include room and board)
$______________
7.
Total financial assistance including scholarships, grants, etc. per semester (public or private, excluding student loans):
Source
Amount
Beginning Date
Ending Date
Scholarships
$
Grants
$
Work Study
$
I hereby certify that the statements above are true and complete to the best of my knowledge.
Signature
Date
Print Name
Title
Address
Email Address
City, State Zip
Phone
Penalties for Misusing This Content: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures
or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any
person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and
fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be
appropriate, against the officer or employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security
number are contained in the Social Security Act at 208 (a) (6), (7), and (8). Violations of these provisions are cited as violations of 42 USC 408 (a), (6), (7), and (8).
Student Status and Financial Aid Verification (2019)