College of DuPage
Office of Student Financial Assistance
Last Name:
Student ID:
2015-2016 V4-V5 Identity Worksheet
First Name:
Student Date of Birth:
M.I.
Your 2015-2016 Free Application for Federal Student Aid (FAFSA) was selected for “VERIFICATION” by the Federal
Processor/Institution. This means we are required to confirm the information you reported on your FAFSA. If there is
conflicting information, we may make a correction to your FAFSA and/or ask for additional information. Failure
to submit requested documents will result in your financial aid not being processed. If you have questions about
verification, contact the College of DuPage Office of Student Financial Assistance as soon as possible so that your
financial aid will not be delayed.
A. High School Completion Status
You must provide one of the following documents that indicate the your high school completion status
when the you will begin college in t h e 2015-2016 academic school year to College of DuPage
Office of Student Records. Contact the Office of Student Records by phone at (630) 942-3838 or via
email at recordsoffice@cod.edu.
Check the box of the document you are submitting to College of DuPage Office of Student Records:
A copy of your final official High School transcript that shows the date when the diploma was
awarded.
A copy of your General Education Development (GED) transcript.
d An academic transcript that indicates you successfully completed at least a two-year program
acceptable for full credit toward a Bachelor’s Degree.
d If you were a homeschooled student, a transcript or equivalent, signed by the parent or guardian,
listing secondary school courses you have completed and documentation that you have successfully
completed secondary school education.
d If you were a homeschooled student, a secondary school completion credential if required under
State law.
d If you received the equivalency of a High School diploma in your country of origin, contact College of
DuPage Student Records for the appropriate documentation to submit to verify the completion of a
High School diploma or its equivalency.
B. Supplemental Nutrition Assistance Program (SNAP) Benefits
d Check if anyone in your household, as reported on your 2015-2016 FAFSA, received SNAP benefits during
2013 or 2014. I will submit documentation of benefits if requested.
The college will not discriminate in its programs and activities on the basis of race, color, religion, creed, national origin, sex, age, ancestry,
marital status, sexual orientation, arrest record, military status or unfavorable military discharge, citizenship status, physical or mental handicap
or disability (Board Policy 5010; 20-5).
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Student’s Name:
ID:
C. Documentation of Identity & Statement of Educational Purpose
The student must appear in person at the Office of Student Financial Assistance at the College of
DuPage to verify his or her identity by presenting a 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 with the date it was received and the name of the
official at the institution authorized to collect the student’s ID. (If the student is unable to appear in
person, contact the Office of Student Financial Assistance for further instructions.)
In addition, the student must sign in the presence of the institutional official, the following:
STATEMENT OF EDUCATIONAL PURPOSE
I certify that I
am the individual signing this Statement of
(Print Student Name)
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 College of DuPage for 2015-2016.
Student Signature
Date
Student ID Number
Financial Aid Administrator Signature
Date
CERTIFICATION:
I certify that all information on this form is true, complete and accurate. Upon request I agree to provide additional
proof of the information reported on this form. Warning: If you purposely give false or misleading information, you
may be fined up to $20,000, sent to prison, or both.
Student Signature
Date
Please return this form to:
College of DuPage, Office of Student Financial Assistance – SSC 2220
425 Fawell Blvd., Glen Ellyn, IL 60137 FAX (630) 942-2151 EMAIL: financialaid@cod.edu
The college will not discriminate in its programs and activities on the basis of race, color, religion, creed, national origin, sex, age, ancestry,
marital status, sexual orientation, arrest record, military status or unfavorable military discharge, citizenship status, physical or mental handicap
or disability (Board Policy 5010; 20-5).
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04/23/15