2016-2017 Verify H.S. Completion & Identity
Office of Financial Aid
FORM V4
Your 2016-2017 Free Application for Federal Student Aid (FAFSA)
STUDENT INFORMATION
was selected for review in a process called verification. In order to
process your financial aid for the 2016-2017 academic year, we
need to gather additional information about you, as required by the
U.S. Department of Education (34 CFR, Part 668).
Name
To verify the accuracy of the information provided on your
application, we will compare your FAFSA with the information on
Student ID Number
this document and with any other required documents. Saint Xavier
University reserves the right to make all necessary changes to your
Student Aid Report (SAR).
Phone Number
If you have questions about the verification process, please contact
the Office of Financial Aid at (773) 298-3070 or [email protected].
You must complete and submit this form, along with the additional documentation requested, before your financial aid will
be processed. Failure to do so will result in a delay of financial aid processing or possible loss of eligibility.
RECEIPT OF SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) BENEFITS
Check the appropriate box:
 No, no one in my household received benefits from SNAP anytime during 2014 or 2015.
 Yes, I certify that
, a member of my household (included on page one) received
benefits from SNAP sometime during 2014 or 2015. SNAP may be known as another name in some states. For assistance
determining the name used in a state, please call 1-800-4FED-AID.
Please note: If SXU has reason to believe that the information provided regarding the receipt of SNAP benefits is inaccurate, we may require
documentation from the agency that issued the SNAP benefits in 2014 or 2015.
HIGH SCHOOL COMPLETION STATUS
Attach and submit one of the following documents that will indicate your high school completion status at the time you begin
college in 2016-2017:
 A copy of your high school diploma, or final official high school transcript that shows the date when the diploma was awarded
 A copy of your “secondary school leaving certificate” (or similar document) if you completed secondary education in a foreign country
 A copy of your state certificate/transcript demonstrating you passed a State-authorized examination that your State recognizes as
the equivalent of a high school diploma (e.g. GED test, HiSET, TASC, or other State-authorized examination)
 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
 A homeschool diploma, or a transcript signed by parent/guardian (if your home state does not require a completion credential) that
lists the secondary school courses you completed and documents the successful completion of a secondary school education in a
homeschool setting
IDENTITY & STATEMENT OF EDUCATIONAL PURPOSE
Instructions: The student must appear in person at Saint Xavier University 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 Education 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 Saint Xavier University for 2016-2017.
Student Signature
SXU Student ID Number
Date
_______________________________________________
Witness Signature (SXU Financial Aid Staff Member)
____________________
Witness Printed Name
_______________
Date
Please note: To be valid, this portion of the document MUST be signed at Saint Xavier University, in the presence of Office of Financial Aid staff
If you are unable to come to campus to sign this Statement of Educational Purpose, you may contact us to request FORM V4-N, a
version of this document that can be completed remotely in the presence of a notary.