Cal Grant Gpa Verification Form - California Student Aid Commission

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Cal Grant GPA Verification Form

DEADLINE: MARCH 2, 2017

(POSTMARKED)

For 2017-18 Academic Year

DO NOT SEND ACADEMIC TRANSCRIPTS

TO BE FILLED OUT BY STUDENT

( SEE BACK OF FORM FOR INSTRUCTIONS)

Please print clearly using blue or black ink only.

2. Month/year

Your Social Security number

of high school

or Dream Act ID number:

graduation

(If currrently a HS senior, anticipated date)

Re-enter your Social Security

or Dream Act ID number:

Your name — last, first, middle initial, as it is listed on your Social Security card and FAFSA:

(

)

Your date of birth:

5. Telephone number:

Your permanent mailing address:

CSAC USE ONLY

Your e-mail address, if available:

Fill in bubble if you are submitting a SAT, ACT, GED, TASC or HiSET test score instead of a GPA.

Attach your applicable test score to this form, transcripts will not be accepted. You do not have to have your school fill out the FOR SCHOOL USE ONLY section

STUDENT CERTIFICATION: I have read the instructions and information accompanying this form. I understand that this Cal Grant GPA

Verification Form is used to determine Cal Grant eligibility and the GPA must be calculated as described on the attached GPA Calcula-

tion Instruction sheet. The information I have completed is true to the best of my knowledge, and I understand that it is illegal to report

false or misleading information. I understand that without a valid Social Security number and signature, this form will not be considered.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

_____________________________________________________________

________________________________________

Student Signature

Date

FOR SCHOOL USE ONLY (High schools MUST be fully accredited by the Western Association of Schools and Colleges [WASC] or an

equivalent regional accreditation agency to certify a Cal Grant high school GPA)

GPA VERIFIER’S SCHOOL CODE:

STATEWIDE STUDENT ID (SSID) :

GPA IS BASED ON HIGH SCHOOL COURSEWORK?

GPA CANNOT

BE ABOVE 4.00

CALIFORNIA COMMUNITY COLLEGE REESTABLISHED GPA?

The signature of the high school or college official certifies, under penalty of perjury, that the GPA is calculated as described on the attached GPA

Calculation Instruction sheet. The signature of a high school official also certifies that his or her high school is fully accredited by the WASC or other

regional accrediting agency, or has a UC-approved course list as required by California regulations. I declare under penalty of perjury under the

laws of the State of California that the foregoing is true and correct.

_____________________________________________________________

________________________________________________

Signature of School Official

Name of School

_____________________________________________________________

________________________________________________

Title of School Official

Street Address of School

_____________________________________________________________

________________________________________________