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2021-2022 Verification Worksheet
Tracking Group (V4)-Custom
Your 2021-2022 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The
law says that, before awarding Federal Student Aid, we may ask you to confirm the information you reported on your FAFSA. To
verify that you provided correct information, we will compare your FAFSA with the information on this institutional verification
document and with any other required documents. If there are differences, your FAFSA information may need to be corrected.
You and a parent whose information was reported on the FAFSA must complete and sign this institutional verification document,
attach any required documents, and submit the form and other required documents to us. We may ask for additional
information. If you have questions about verification, contact us as soon as possible so that your financial aid will not be delayed.
A. Student’s Information
_________________________________________________ ___________________________________________ __________________ ______________________________
Last Name First Name M.I. Last 4 Digits of SSN
____________________________________________________________________________ ___________________________ ____________ ____________________
Address City State Zip Code
__________________________________________________ ___________________________________________ _______________________________________________
ASU ID Number Email Address Home or Cell Phone Number
B. High School Completion Status
Provide one of the following documents that will indicate your high school completion status when you begin college in 2021–
2022:
A copy of your high school diploma.
A copy of your final official high school transcript that shows the date when the diploma was awarded.
A state certificate or transcript you received after you passed a State-authorized examination (GED test, HiSET, TASC, or
other State-authorized examination) that the State recognizes as the equivalent of a high school diploma.
If you completed secondary education in a foreign country, a copy of the “secondary school leaving certificate” or other
similar document.
An academic transcript that indicates you successfully completed at least a two-year program that is acceptable for full
credit toward a bachelor’s degree.
If you were homeschooled in a state where state law requires you to obtain a secondary school completion credential for
home-school (other than a high school diploma or its recognized equivalent), a copy of that credential.
If you were homeschooled in a state where state law does not require you to obtain a secondary school completion
credential for home-school (other than a high school diploma or its recognized equivalent), a transcript or the equivalent,
signed by your parent or guardian, that lists the secondary school courses you completed and includes a statement that you
successfully completed a secondary school education in a home-school setting.
Contact the financial aid office if you are unable to obtain the documentation listed above.
C. Identity and Statement of Educational Purpose (To Be Signed in the Presence
of a Notary)
If you are able to appear in person at Alcorn State University
(Name of Postsecondary Educational Institution) to verify your
identity, you must provide:
(a) A copy of the unexpired-valid government-issued photo identification (ID) that is acknowledged in the notary
statement below or that is presented to a notary, such as, but not limited to, a driver’s license, other state-issued
ID, or passport. Alcorn State University 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
receive and review the student’s ID.
If you are unable to appear in person at Alcorn State University
(Name of Postsecondary Educational Institution) to verify your
identity, you must provide:
(b) A copy of the unexpired-valid government-issued photo identification (ID) that is acknowledged in the notary
statement below or that is presented to a notary, such as, but not limited to, a driver’s license, other state-issued
ID, or passport; and
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Student’s Name: _____________________________________________________________________________ Last 4 Digits of Student’s SSN: __________
(c) The original Statement of Educational Purpose, which is provided below, must be notarized.
Statement of Educational Purpose
I certify that I, _________________________________________________ (Print Student’s 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 ________________________________________________ (Name of Postsecondary Educational Institution) for
2021–2022.
____________________________________________________________________ ______________________________ ________________________
Student Signature Date ASU ID Number
Notary’s Certificate of Acknowledgement
State of ___________________________________________________City/County of ___________________________________________________________________
On____________________________ (Date), before me, __________________________________________, (Notary’s name) personally appeared
__________________________________________ (Printed name of signer) and proved to me 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)
E. Certification and Signature
Each person signing this worksheet certifies that all of the information reported on this worksheet is complete and correct. The
student must sign this worksheet along with parent. If married, the spouse’s signature is optional.
________________________________________________________________________ _______________________________________
Student’s Signature Date
_________________________________________________________________________________________ _________________________________________________
Parent’s Signature Date
_______________________________________________________________________________________ _________________________________________________
ASU Financial Aid Staff Member’s Signature Date
(ONLY IF WITNESSING IN-PERSON SIGNATURES OF STUDENT AND PARENT)
_____________________________________________________________________________________________________________________________________________
ASU Financial Aid Staff Member’s Name & Title
(IF SIGNED ABOVE, MUST ALSO COPY ORIGINAL ID’S)
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to
jail, or both.
Return Form to:
Alcorn State University
Office of Student Financial Aid
1000 ASU Drive, 28
Alcorn State, MS 39096-7500
Fax: (601) 877-6110
Email: asufinaid@alcorn.edu
