A Driver Financial Aid

Mid-America Christian University **** - **

Custom Verification Worksheet Independent V4

A. Independent Student’s Information

Name: SSN #:

Address:

Date of Birth: Phone Number:

B. Independent Student’s Family Information

Number of Household Members: List below the people in the student’s household. Include:

The student.

The student’s spouse, if the student is married.

The student’s or spouse’s children if the student or spouse will provide more than half of the children’s support from July 1, 2020, through June 30, 2021, even if a child does not live with the student.

Other people if they now live with the student and the student or spouse provides more than half of the other person’s support, and will continue to provide more than half of that person’s support through June 30, 2021. Number in College: Include in the space below information about any household member who is, or will be, enrolled at least half time in a degree, diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, 2020, and June 30, 2021, and include the name of the college. If more space is needed, provide a separate page with the student’s name and ID number at the top. Full Name Age Relationship College Will be enrolled at least halftime?

John Smith (example) 28 Spouse Central University Yes Self

Note: We may require additional documentation if we have reason to believe that the information regarding the household members enrolled in eligible postsecondary educational institutions is inaccurate. Mid-America Christian University Custom Verification Independent 2020-2021 C. High School Completion Status

Provide one of the following documents to indicate the student’s high school completion status when the student begins college in 2010–2021:

A copy of the student’s high school diploma.

For students who completed secondary education in a foreign country, a copy of the “secondary school leaving certificate” or other similar document.

A copy of the student’s final official high school transcript that shows the date when the diploma was awarded.

A State certificate or transcript received by a student after the student passed a State-authorized examination that the State recognizes as the equivalent of a high school diploma (GED test, HiSET, TASC, or other State-authorized examination).

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 student who was homeschooled in a State where State law requires the student to obtain a secondary school completion credential for homeschooling (other than a high school diploma or its recognized equivalent), a copy of that credential.

For a student who was homeschooled in a State where State law does not require the student to obtain a secondary school completion credential for homeschooling (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. Mid-America Christian University Custom Verification Independent 2020-2021 Identity and Statement of Educational Purpose

(To be signed at MACU)

The student must appear in person at Mid-America Christian University to verify his or her identity by presenting an unexpired 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 receive and review 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 am the individual signing this Statement of Educational

(Print Student’s Name)

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 Mid-America Christian University for 2020–2021.

(Student’s Signature) (Date)

(Student’s ID Number)

Official Use Only:

[ ] Check here if the student appeared in person and presented one of the following photo documents. Driver’s License Other Passport

State Issued I.D.

School Official’s Name Date Accepted

If you are not able to appear at MACU in person, please see the instructions on the following page and submit it along with the rest of this document.

Mid-America Christian University Custom Verification Independent 2020-2021 Identity and Statement of Educational Purpose

(To Be Signed in the Presence of a Notary)

If the student is unable to appear in person at Mid-America Christian University to verify his or her identity, the student must provide to the institution:

(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; and

(b) The original Statement of Educational Purpose provided below, which 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 am the individual signing this Statement of Educational

(Print Student’s Name)

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 Mid-America Christian University for 2020–2021.

(Student’s Signature) (Date)

(Student’s ID Number)

Notary’s Certificate of Acknowledgement

State of City/County of On, before me,,

(Date) (Notary’s name)

personally appeared,, and provided to me

(Printed name of signer)

on the 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)

Mid-America Christian University Custom Verification Independent 2020-2021 D. Certification and Signature

Each person signing below certifies that all of the information reported is complete and correct. Print Student’s Name Student’s ID Number

Student’s Signature (Required) Date

Spouse’s Signature (Optional) Date

Return to: Mid-America Christian University

Financial Aid Office

3500 SW 119th Street, Oklahoma City, Oklahoma 73170 Fax: 405-***-****

Email: adtzsa@r.postjobfree.com

WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.

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