2015-2016 BANKRUPTCY STATUS FORM
STUDENT INFORMATION
Please complete this verification form and provide copies of all requested paperwork within 15 days of receipt to Governors
State University. Incomplete paperwork will not be accepted, thereby delaying the processing of your financial aid
award.
Student Name: _________________________________________________
Please Print
Last
First
GSU ID #____________________
Last 4 digits of SS#:__________________
Permanent Home Address: ___________________________________________________________________________________________________________ ______
City
State
Zip Code
Student’s Date of Birth: ____________________________Home Phone #: __________________________________Cell #: ______________________________
Email Address: ______________________________________________________
WHAT YOU SHOULD DO:
The National Student Loan Data System (NSLDS) has notified our office that you are currently in active bankruptcy. To determine
eligibility for federal student aid we will need;
•
•
Documentation from the holder of your debt stating the debt is dischargeable or has been discharged.
Or
Copies of all letters received from the U.S. Department of Education or your lender explaining your student loan status.
Return this original form along with documentation to our office
CERTIFICATION AND SIGNATURES
Each person signing this worksheet certifies that all of the information reported on it is complete and correct. The student
must sign and date this worksheet.
__________________________________________________________________________________
Student’s Signature
Date
WARNING: If you purposely give false or
misleading information on this worksheet, you
may be fined, be sentenced to jail, or both.
CRI CODE: FAC15BKY