15SHOUSE
0102 Lee Building
College Park, Maryland 20742-5145
TEL: 301-314-9000 & 888-313-2404
TTY: 301-314-7017 (for the hearing impaired)
FAX: 301-405-9265 & 301-314-9587
www.financialaid.umd.edu
OFFICE OF STUDENT FINANCIAL AID
2015-2016 Student Housing Status Form
Student Name: UID:
The Office of Student Financial Aid has completed an initial review of your Free Application for Federal Student Aid (FAFSA). Additional information is needed to clarify your housing status. You must answer all questions on this form and provide supporting documentation. If you answer NO to all of the questions below, you must go back to your 2015-2016 FAFSA, review and change your YES answer(s) to questions 53-58, provide parental information with signature and submit a correction.
Please submit this form along with supporting documentation to
the Office of Student Financial Aid
1. At any time since you turned age 13, were both your parents deceased, were you in foster care or were you a dependent or ward of the court?
If yes, please provide legal documentation. Yes ____ No ____
2. As determined by a court in your state of legal residence, are you or were you an emancipated minor? If yes, please provide legal documentation. Yes ____ No ____
3. As determined by a court in your state of legal residence, are you or were you in legal guardianship? If yes, please provide legal documentation. Yes ____ No ____
4. At any time on or after July 1, 2014, did your high school or school district homeless liaison determine that you were an unaccompanied youth who was homeless or self-supporting and at risk of being homeless? If yes, please provide a letter of documentation. Yes ____ No ____
5. At any time on or after July 1, 2014, did the director of an emergency shelter or transitional housing program funded by the U.S. Department of Housing and Urban Development determine that you were an unaccompanied youth who was homeless or were self-supporting and at risk of being homeless? If yes, please provide a letter of documentation. Yes ____ No ____
6. At any time on or after July 1, 2014, did the director of a runaway or homeless youth basic center or transitional living program determine that you were an unaccompanied youth who was homeless or were self-supporting and at risk of being homeless? If yes, please provide a letter of documentation. Yes ____ No ____
By signing this form, I certify all information reported on this form and within the enclosed documentation is complete and correct. I understand that providing false or misleading information may result in a $20,000 fine, a prison sentence, or both, according to the Higher Education Act of 1965, as amended, Section 490(a). Any false or misleading information is subject to cancellation of all financial assistance.
Student’s Signature: Date: