2425 V4 Verification Worksheet

2024-2025 Verification Worksheet (V4)
Your 2024-2025 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called
“Verification”. The Financial Aid Office at Randolph College must compare information from your FAFSA with the
information you provide on this worksheet and with any other required documents. If there are differences, your
Financial Aid Office could require additional documentation and your FAFSA information may need to be corrected.
You will not receive federal financial aid until all verification requirements are met and the necessary corrections
made.
A. Student’s Information
Students Last Name First Name M.I. Student’s Social Security Number
Student’s Street Address (include apt. number) Student’s P#/People Code ID
City, State, Zip Code Student’s Date of Birth
Student’s Phone Number (include area code) Student’s Email Address
B. Identity and Statement of Educational Purpose
You must appear in person and present VALID* government issued photo identification.
[*Valid forms of Identification (ID) are non-expired, government-issued, and include, but not limited to:
State-issued driver’s license, other state-issued ID, or passport.]
Identity and Statement of Educational Purpose
The above-named student must appear in person at Randolph College to verify their identity by presenting an
unexpired valid government-issued photo identification (ID). 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 (or notary public official), the
following:
Statement of Educational Purpose
I certify that I, __________________________________________ am the individual signing this Statement of Educational

(Print Student 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 Randolph College for the 2024-2025 Academic Year.
Student’s Signature: ______________________________________ Date: ___________________
[STOP! To be signed at Financial Aid Office OR in front of Notary Public Official]

If you are unable to appear in person, see page 2.
FA Certifying Officer’s Signature Date Received Type of Valid ID Collected and Copied
2024-2025 Verification Worksheet (V4) Page 1 of 2

Student Name: ________________________ Student P#: P __ __ __ __ __ __ __ __ __
If you are unable to appear in person, check this box and complete the notary section below.
I am unable to appear in person at Randolph College to verify my identity, and instead have signed the
Statement of Education Purpose (page 1) in front of a notary public official. Attached is a copy of the valid
government issued photo identification used and an original notarized statement of educational purpose
(below).
Notary’s Certificate of Acknowledgement
State of _______________ ) SS:
County of _____________ )
The foregoing instrument was acknowledged before me this _____day of ________, 20__ by __________________,
who appeared before me and has produced as a valid photo ID ________________________________________
(Type of ID and ID #)
with an expiration date of _____________________.
WITNESS my hand and official seal:

(Rubber Stamp/Seal) __________________________________ My commission
(Notary Signature) expires:
___________
__________________________________ (Date)
(Notary Printed Name)
C. Certification and Signatures – Student MUST sign.

I certify that all the information reported on this worksheet is complete and correct. I/we understand that if we
purposely give false or misleading information, we could be fined, jailed, or both.
Student’s Signature (Required) Date
IMPORTANT: Verification cannot be completed until ALL required documents are received.
➢ Do not mail this worksheet to the U.S. Department of Education. Submit this worksheet to the
Financial Aid Office at Randolph College.
➢ You should make a copy of this worksheet, and all submitted documents for your records.
This verification form is required to be printed and signed. If you are unable to or don’t have access to a printer,
please contact our office at 434-947-8128 or [email protected] and we will be happy to mail
you the documents needed.
How to Submit:
• SecureFile: https://randolphfa.securefilepro.com/portal/#/login
• Mail: Randolph College, Office of Financial Aid, 2500 Rivermont Ave., Lynchburg, VA 24503
• In-Person: Admission Welcome Center, 2711 Rivermont Ave., Lynchburg, VA 24503
2024-2025 Verification Worksheet (V4) Page 2 of 2

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2024-2025 Verification Worksheet (V4)

Student’s Street Address (include apt. number) Student’s P#/People Code ID

City, State, Zip Code Student’s Date of Birth

Student’s Phone Number (include area code) Student’s Email Address

B. Identity and Statement of Educational Purpose

Statement of Educational Purpose

I certify that I, __________________________________________ am the individual signing this Statement of Educational

Student’s Signature: ____________________ Date: _

[STOP! To be signed at Financial Aid Office OR in front of Notary Public Official]

2024-2025 Verification Worksheet (V4) Page 1 of 2

Notary’s Certificate of Acknowledgement

State of _______________ ) SS:

WITNESS my hand and official seal:

C. Certification and Signatures – Student MUST sign.

Student’s Signature (Required) Date

2024-2025 Verification Worksheet (V4) Page 2 of 2

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