Chowan University
Financial Aid Office
One University Place
Murfreesboro, NC 27855
Phone: 252-398-6535
Fax: 252-398-6513
Email: [email protected]
Priority Dates
Returning Students
February 28, 2017
New Students
April 30, 2017
Financial Aid Office
2017-2018 Proof of Physical Address
The purpose of this form is to provide proof of you and/or your parent’s physical address and connection to a physical address to
resolve any conflicting information we have received.
A. Student’s Information
Student’s Name
Date of Birth
Mailing Address
Home Phone
Student’s Cell Phone
SSN
XXX-XX-
B. Parent’s Current Marital Status
Please select only one.
Never Married
Date Divorced:_______________
Unmarried, both parents living together
Date Separated:______________
Date Married:_______________
Date Widowed:_______________
Date Remarried:_____________
C. Parental Information
Parent 1’s Information
First Name
Last Name
Social Security Number
Date of Birth
Phone Number
Email Address
Physical Street Address (Not PO
Box)
City, State, Zip
Parent 2’s Information
First Name
Last Name
Social Security Number
Date of Birth
Phone Number
Email Address
Physical Street Address (Not PO
Box)
City, State, Zip
Proof of Physical Address
1
STUDENT NAME: __________________________________________ CHOWAN ID #:____________________
D. Personal Statement
Please explain to us why there is a conflict in your/your parent’s physical address. Attach additional sheets if needed;
remember to include the Student’s Name and Chowan ID Number on all correspondence.
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
E. Required Documentation
Please see the attached form with the list of the acceptable documentation that is required to provide proof of your physical
address and connection to a physical address.
F. Certification and Signatures
By signing below, I/we certify the information reported on this worksheet is complete and accurate and authorize the
Financial Aid Office to perform necessary electronic corrections to the FAFSA on my behalf. I/we agree to provide proof of
any information reported on this form or on my FAFSA. I/we realize that any false statement or failure to give proof when
asked may be cause for denial, reduction, withdrawal, and/or repayment of my financial aid. I/we also understand if we
purposely give false or misleading information I/we may be fined, sentenced to jail, or both. If you are a dependent
student, one parent must sign below.
________________________________________________
(Student’s Signature)
________________________________________________
(Parent’s/ Spouse’s Signature)
____________________
(Date)
____________________
(Date)
Please return to:
Chowan University Financial Aid Office * One University Place * Murfreesboro, NC 27855
Fax 252-398-6513 * Email [email protected] * Phone 252-398-6535
Proof of Physical Address
2
Chowan University
Financial Aid Office
One University Place
Murfreesboro, NC 27855
Phone: 252-398-6535
Fax: 252-398-6513
Email: [email protected]
Priority Dates
Returning Students
February 28, 2017
New Students
April 30, 2017
Financial Aid Office
Documentation for Proof of Physical Address
Please choose one of the following combinations to provide complete proof of physical address or a connection to a physical address.
1.
2.
3.
4.
Two documents from Section A.
One document from Section A and one document from Section C.
One document from Section B and one document from Section C.
If your parents live with someone and they cannot provide a utility bill in their name with the service address, please provide:
one documentation from Section B and another piece of mail in your parent’s name addressed to the same service address.
SECTION A
Documents that establish proof of physical address and proof of connection with physical address
A1
A2
A3
A4
Electric bill in parent's name
Gas bill in parent's name
Water bill in parent's name
Cable/Internet in parent's name
A5
A6
A7
A8
Complete lease agreement in parent's name
Mortgage agreement in parent's name
Phone bill with service address in parent's name
Property tax statement in the parent's name
SECTION B
Documents that establish proof of physical address
B2
Electric bill in landlord, relative, or friend's
name
Gas bill in landlord, relative, or friend's name
B3
Water bill in landlord, relative, or friend's name
B1
B4
Cable/Internet bill in landlord, relative, or friend's name
B5
Complete lease agreement in landlord, relative, or friend's name
Phone bill with service address in landlord, relative, or friend's
name
B6
SECTION C
Documents submitted must be addressed to the Parent and have the same address as the proof provided in Section A or B
C1
C2
C3
Bank or Financial statement in parent's name
Car insurance in parent's name
Cell phone bill in parent's name
C4
C5
C6
Credit card statement in parent's name
Computer generated paycheck or paycheck stub in parent's name
Phone bill without service address in parent's name
Unacceptable for both proof of physical address and connection with physical address
U1
U2
U3
U4
Any altered document
Change of address form or confirmation
Court documents
Driver's License
U8
U9
U10
U11
Postcards
Magazines
Anything else addressed to "Parent" or "Current Resident"
Sales flyers addressed to parent
Please return to:
Chowan University Financial Aid Office * One University Place * Murfreesboro, NC 27855
Fax 252-398-6513 * Email [email protected] * Phone 252-398-6535
Proof of Physical Address
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