Non-SSN GPA verification form

NON-SSN Cal Grant
GPA Verification Form
DEADLINE: MARCH 2, 2014 (POSTMARKED)
*March 2 is a Sunday, so GPA forms will be accepted if postmarked by March 3, 2014
DO NOT SEND ACADEMIC TRANSCRIPTS
For 2014-15 Academic Year
( SEE BACK OF FORM FOR INSTRUCTIONS)
Please print clearly using blue or black ink only.
Student Information Section
1. Your Name ( Last, First, Middle Initial)
L
a s t
F
2. Your Date of Birth (MM/DD/YYYY)
D D
M M
Y Y Y Y
i
3. Enter Your Gender
M = Male
F = Femaie
r s
M
t
4. Enter Month/Year of High School Graduation
M M
Y Y Y Y
(If currently a HS Senior,
enter anticipated date)
5. Your E-mail address
CSAC USE ONLY
6. Your permanent mailing address
A d d r
C i
t
e s
s
C A
y
Z
i p
7. Fill in bubble if you are submitting a SAT, ACT or GED 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
Parent Information Section
8. Father’s Last Name
L
a s t
9. Mother’s Last Name
N a m e
10. Parents Phone number
L
a s t
N a m e
11. Parents E-mail Address
12. 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 Calculation 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 complete form 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
____________________________________________________
Student Phone Number
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:
STUDENT’S STATE STUDENT ID (SSID) :
O p t i
o n a l
.
GPA IS BASED ON HIGH SCHOOL COURSEWORK?
GPA CANNOT
BE ABOVE 4.00
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 OfficialName of School
Title of School Official
Date E-mail Address
Street Address of School
City
State
Zip Code
Mail completed form to: California Student Aid Commission, Cal Grant Operations, P.O. Box 419077, Rancho Cordova, CA 95741-9077
Instructions for filling out the Cal Grant GPA Verification Form
Please print clearly using blue or black ink only. Filing deadline for 2014-15 awards is March 2, 2014
NOTE: Students must complete Student Info Section AND Parent Information Section
Student Information Section
1. Your name: Print your full name as it appears on your Social Security card. Enter last name, first name, middle initial.
2. Your date of birth: Enter your birth date. For example, June 25, 1996 would be entered as 06-25-1996.
3. Your Gender Enter “M” for male and “F” for femail
4. Month/year of high school graduation: Enter the month and year you graduated, or plan to graduate from high school. Enter the month in a
two-digit format (for example: January should be appear as “01”; November should appear as “11”). Enter the year in a four-digit format (for
example: 2014 should appear as “2014”).
5. Your E-mail address: Enter a “safe” e-mail address where you can be contacted for questions. This is optional.
6. Your permanent mailing address: Enter your permanent mailing address, city, state and five-digit zip code.
7. Submitting a test score instead of a GPA: Complete questions 1 through 10, sign the form and attach a photo copy of the testing organization’s
score report and mail by the deadline to Commission. TRANSCRIPTS and DIPLOMAS WILL NOT BE PROCESSED.
The results from the GED, SAT or ACT tests must be submitted in lieu of a GPA if:
nYou participated in a home schooling program or attended an unaccredited high school.
nYou attended a high school or college outside of the United States and are unable to have those grades converted to a 4.00 scale or your
nStudents who have been out of school for five years can choose to submit either test scores or their GPA.
school did not grade in a manner that can be readily converted to a 4.00 scale.
– Scores from the California High School Proficiency Examination (CHSPE) cannot be accepted in lieu of a high school GPA, but
passing the CHSPE does meet the high school graduation requirement of the Entitlement Cal Grant program. Also, grade reports, transcripts, and other proficiency certificates WILL NOT BE ACCEPTED.
– Only scores from the SAT reasoning test WILL BE ACCEPTED. Subject test scores will NOT BE PROCESSED.
Parent Information Section and Student Certification
8. Father’s Last Name: Enter your Father’s Last name as it appears on your financial aid application (FAFSA or DREAM Act Application)
9. Mother’s Last Name: Enter your Mother’s Last name as it appears on your financial aid application (FAFSA or DREAM Act Application)
10. Parent’s Phone Number: Enter your Parent’s Phone number as it appears on your financial aid application (FAFSA or DREAM Act Application)
11. Parent’s E-mail Address: Enter your Parent’s E-mail address as it appears on your financial aid application (FAFSA or DREAM Act Application)
12. Student Certification: By signing this form, you certify that you have read these instructions and that the information you provided is correct.
It is illegal to report false or misleading information on this form and doing so may result in any Cal Grant award being revoked.
Once you have filled out the student information, take the form to your school and request that they verify your GPA. Be aware that if your
school will be electronically submitting your GPA to the California Student Aid Commission, you do not need to submit this form. It is your
responsibility to verify that the school will be submitting your GPA for you.
FOR SCHOOL USE ONLY SECTION
STATE STUDENT IDENTIFICATION NUMBER: (Optional) Please enter the 10-Digit State Student Identification Number (SSID) of
the student who’s GPA is listed on this form. If the student does NOT have a SSID,
please leave blank.
GPA IS BASED ON HIGH SCHOOL COURSEWORK:
Fill in this bubble ONLY if the GPA is based on high school coursework.
GPA VERIFIER’S SCHOOL CODE:
High schools use their College Board school code; colleges use their USED OPE ID
VERIFIED STUDENT GPA:
Fill in ALL three GPA spaces. Cal Grant GPAs are calculated on a 4.00 scale. High Schools certifying GPAs MUST be accredited or have a UC approved course list in order to verify GPAs. Students not attending accredited high schools should provide either a GED, SAT or ACT score.
After the school completes the GPA information, we recommend making a copy for your records, and purchasing a $1.20 Certificate of Mailing from the post office and mail to:
California Student Aid Commission
Cal Grant Operations
P.O. Box 419077
Rancho Cordova, CA 95741-9077
G-4
(09/2013)
Cal Grant GPA Calculation Instructions
There are four categories of GPAs used for Cal Grant award selection - High School, College, Regular
Community College and Reestablished Community College.
High School GPA
College GPA
A high school GPA is calculated on a 4.00 scale to two decimal
places (between 0.00 and 4.00). Do not use a weighted scale.
Convert any grades with extra weighting for honors and
advanced placement classes to a 4.00 scale before calculating
the GPA. GPAs calculated beyond a 4.00 scale will not be
accepted.
A college GPA is calculated on all college work completed,
except for nontransferable units and courses not counted in
the computation for admission to a California public institution
of higher education that grants a baccalaureate degree. The
definition of the phrases “all college work completed” and
“nontransferable units” and “courses not counted in the
computation for admission to a California public institution
of higher education that grants a baccalaureate degree” are
described below. A college GPA or a community college GPA
must be computed for a minimum of 24 semester units or its
equivalent regardless of the grades received. The phrase “all
college work completed” includes all coursework for which grades
are known to the official reporting the GPA and that are accepted
for credit at the school reporting the GPA. Failing grades must be
included.
For students who have not yet graduated high school, calculate
the GPA using all academic course work for the sophomore
year, the summer following the sophomore year, the junior year,
and the summer following the junior year. The high school GPA
excludes physical education (PE), Reserve Officer Training
Corps (ROTC), and remedial courses. Remedial work is defined
as any course that is not counted toward high school graduation.
Failing grades must be included in the GPA calculation unless
the course has been retaken.
GPAs for “accelerated” high school juniors graduating in spring
should be calculated using academic course work earned during
the student’s sophomore year and the summer following the
sophomore year, as well as all course work completed in the
junior year by the time of certification.
For students who are out of high school but have not earned
sufficient college level units to allow calculation of either a college
GPA or reestablished GPA or as explained below, the GPA must
be calculated from high school course work earned from the
student’s sophomore year onward, regardless of whether the
student graduated. Competitive Cal Grant awards can be made to
students who have not graduated high school.
Regular California Community College GPA
For purposes of computing a community college GPA for a Cal
Grant award, “nontransferable units” and “courses not counted
in the computation for admission to a California public institution
of higher education that grants a baccalaureate degree” mean
all courses except “Associate Degree Credit Courses” as defined
by Title 5, Chapter 6, Article 1, Section 55002(a) of the California
Code of Regulations.
Reestablished Community College GPA
A reestablished community college GPA is calculated on at least
16 but less than 24 semester units or the equivalent. For any
Cal Grant deadline, a school may submit either a reestablished
GPA or a “regular” community college GPA calculated on at
least 24 semester units, or the equivalent. A reestablished
GPA is good only for Competitive Cal Grant B consideration.
Only a California Community College may submit a
reestablished GPA.
College GPA - Baccalaureate Degree Granting
Institution
For purposes of computing a college GPA by an institution
that grants a baccalaureate degree, “nontransferable units”
and “courses not counted in the computation for admission to
a California public institution of higher education that grants a
baccalaureate degree” are those courses which do not earn
credit for a baccalaureate degree from the reporting institution.
College GPA - Associate Degree Granting
Institution
For purposes of computing a college grade point average by
a postsecondary institution that grants an associate degree,
“nontransferable units” and “courses not counted in the
computation for admission to a California public institution of
higher education that grants a “baccalaureate degree” are those
courses which do not earn credit for an associate degree at the
reporting institution.
College GPA - Non-degree Granting Institution
For purposes of computing a college GPA by a postsecondary
institution that does not grant a baccalaureate or an associate
degree:
(A) “nontransferable units” are those units which are not used in
satisfying requirements for earning a baccalaureate degree from
a California public institution of higher education that grants such
a degree;
(B) “courses not counted in the computation for admission to
a California public institution of higher education that grants a
baccalaureate degree” are any courses for which the earned
grade is not used in the computation of a GPA in determining
admission eligibility, whether or not units earned for the course
are transferable to such an institution.
If the GPA is based on college units, and is not a reestablished GPA as described above, do not fill in any bubble.