Unaccompanied Homeless Youth Verification

Unaccompanied Homeless Youth Verification

Financial Aid Office: 902 Herring Ave PO Box 4305 Wilson, NC 27893 Phone (252) 291-1195 Fax (252) 243-7148
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Student ID
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Signature giving consent to disclose information to Wilson Community College
Date
I am providing this letter of verification as a (check one):
As per the College Cost Reduction and Access Act (Public Law 110-84), I am authorized to verify this student's living situation. No further verification by a Financial Aid Administrator is necessary. Should you have additional questions or need more information about this student, please contact me at the number listed below.
This letter is to confirm that (name of student)First Name Last Name was:
Check one:
Date of Determination

MonthDayYear
Date
Authorized Signature of Official
Print Name

First NameLast Name
Title
Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Agency
Should be Empty: