Student ID#: ______Name: ______

High School Completion Status Verification

A component of your verification requires that Jefferson College of Health Sciences confirm that you have completed high school. Please provide one of the following documents confirming that you have completed high school. If you have not yet completed high school, but will complete high school before you begin Jefferson College of Health Sciences, only return this form after you have completed high school. Please check one of the following: ______Attached is a copy of my high school diploma. ______Attached is a copy of my final official high school transcript, showing the date that my high school diploma was awarded. ______Attached is a copy of my certificate or official transcript indicating that I successfully completed the GED, HiSET, TASC, or some other State- authorized high school equivalency exam. ______Attached is an academic transcript indicating that I successfully completed at least a two-year program that is acceptable for full credit toward a bachelor’s degree. ______I was homeschooled and my State law requires a student to obtain a secondary school completion credential. Attached is a copy of that credential. ______I was homeschooled and my State law does not require a homeschooled student to obtain a secondary school completion credential. Attached is a transcript or the equivalent, signed by my parent or guardian, that lists the secondary school courses I completed and documents the successful completion of a secondary school education in a home school setting. If you are not able to obtain any of the documentation listed above, please contact the Jefferson College Office of Financial Aid at (888) 985-8483 or (540) 985-8267. By signing this form, I certify that all the information attested to and provided is accurate and correct. Because this information may affect federal aid eligibility, intentionally giving false or misleading information may cause you to be fined up to $20,000.00, sent to prison, or both. Student’s Signature*: ______Date Signed: ______*Your signature must be handwritten; typed and electronic signatures are not accepted.

Jefferson College of Health Sciences’ Office of Financial Aid 101 Elm Avenue, SE Roanoke, VA 24013-2222 Phone: (540) 985-8267 Fax: (540) 224-6916 Email: [email protected]