Pennsylvania State Grant Documents and Forms

If you are:
Interested in learning more about the Pennsylvania State Grant Program

Use this document to:

• Understand how State Grants are calculated
• Identify approved schools (both in state and out of state)

State Grant Form User Guide (PDF)

If you are:
Required to complete the State Grant Form

Use this document to:

• Understand how to access the online State Grant Form
• Understand how to complete the State Grant Form

Instructions

View your status:

1. Sign in to Account Access.
2. Go to "Applications & Status."
3. Select "PA State Grant Status."

Rights and Responsibilities Certification Document (PDF)

If you are:
A State Grant applicant or recipient

Use this document to:

• Understand the Rights and Responsibilities that you have agreed to by providing your signature and accepting an award
• Understand how we use your Social Security number

Academic Progress Exception Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant recipient who during the previous academic year either:

• Withdrew from school before completing the term
• Failed to pass one or more courses

Use this form to:

• Submit documentation to explain the reasons for your lack of academic progress for the current academic year

Instructions

1. Complete the top of the form.
2. Have a financial aid administrator at your school complete the bottom of the form.
3. Have your school submit the form within 30 days (but no later than April 1) to State Grant and Special Programs.

Home Education Certification Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant who either:

• Was home schooled
• Received a diploma through a correspondence school

Use this form to either:

• Certify that you have a high school diploma from a home study organization that the Pennsylvania Department of Education recognizes for issuing diplomas
• Confirm that your education is in compliance with state law

Instructions

1. Complete the form in its entirety.
2. Have your school district's superintendent or designee complete the form in its entirety.
3. Submit the form within 30 days (but no later than April 1).

ADA Accommodation Request Form (PDF)

If you are:
A State Grant recipient who has:

• Been reported by your school as not enrolled at least 50% in the classroom

• A medical disability

Use this form to:

• Request an accommodation (exception) to the State Grant eligibility requirement that states 50% of instruction must be in the classroom

Instructions

1. Talk to your financial aid administrator to ensure that this form is necessary.
2. Read the State Grant Distance Education Policy/Procedure for Students with Documented Disabilities on page 2.
3. Complete the form on page 1 in its entirety.
4. Provide the requested documentation from your treating medical healthcare provider.
5. Submit the form and documentation within 30 days (but no later than April 1).

NOTE: Do not submit the form prior to the start of classes for the term.

Casualty Loss Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant whose:

• Family suffered severe casualty losses as a result of a recent storm, fire, or other disaster

Use this form to:

• Request special consideration regarding your family's reduced ability to finance the costs of school

Instructions

1. Complete the form.
2. Provide the requested tax information.
3. Submit the form no later than
   April 1.

If you are:
A State Grant applicant who:

• Didn't complete the Pennsylvania State Grant Form, click on the Apply Now button in the left column.

To complete the process, be sure to:

1. Sign the last page will all required signatures

2. Mail the completed signature page ONLY to:

   PHEAA
   State Grant and Special Programs
   P.O. Box 8157
   Harrisburg, PA 17105-8157

If you are:
A State Grant applicant who:

• Was directed by PHEAA to fill out this form

Instructions

1. View your incomplete items:
   • Sign in to Account Access.
   • Select "Complete the PA State Grant Form".
2. Provide only the missing items on the status notice. (Do not fill out the entire notice.)
3. Sign and date the status notice.
4. Submit pages 1 and 2 of the status notice. (We do not need you to return the instructions.)
5. Keep the Rights and Responsibilities Certification Document in your personal records.

Reduced Income Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant whose:

• Family income has decreased in comparison to the income that you reported on the FAFSA (Free Application for Federal Student Aid)

Use this form to:
Report reduced income due to one of the following:

• Recent job loss or change (you or your spouse) of at least 2 full months
• Recent retirement (you or your spouse)
• Recent permanent and total disability (your spouse)
• Recent death of your spouse

Instructions

1. Complete the form in its entirety.
2. Provide the requested tax information.
3. Sign and date the form.
4. Submit the form no later than April 1.

Income Validation Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant whose:

• State Grant application was selected for Income Validation Review

Use this form to:
Supply any requested documentation (for both you and your spouse), including:

• U.S. Income Tax Returns
• W-2 Forms
• 1099 Forms
• Other tax-related information

Instructions

1. Gather the requested documentation.
2. Submit the form and documentation within 30 days (but no later than April 1).

Estimated Income Validation Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant whose State Grant application was selected for Income Validation Review because either:

• You provided estimated family income on your FAFSA (Free Application for Federal Student Aid)
• You haven't yet filed a tax return with the IRS

Use this form to:
Supply any requested documentation (for both you and your spouse), including:

• U.S. Income Tax Returns
• W-2 Forms
• 1099 Forms
• Other tax-related information

Instructions

1. Gather the requested documentation.
2. Submit the form and documentation within 30 days (but no later than April 1).

Recent Separation/Divorce Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant who either:

• Has been separated or divorced from your spouse for at least 2 full months since the time you applied
• Was separated or divorced from your spouse before you applied but incorrectly reported joint information

Use this form to:

• Report your adjusted income as a result of the separation or divorce (must be separated or divorced for at least 2 full months)

Instructions

1. Complete the form in its entirety.
2. Sign and date the form.
3. Provide the requested tax information.
4. Submit the form within 30 days (but no later than April 1) after you meet the 2-month requirement.

Medical/Dental Expense Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant whose:

• Family paid extraordinary, out-of-pocket, unreimbursed medical or dental expenses during the year for which information is requested on the FAFSA (Free Application for Federal Student Aid)

Use this form to:

• Request reconsideration of your State Grant application

Instructions

1. Complete the form in its entirety.
2. Provide the requested tax information and documentation.
3. Sign and date the form.
4. Submit the form no later than
   April 1.

Family Size and Number Enrolled Clarification Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant who must confirm:

• The number of people in the household
• The number of people in the household attending college

Use this form to:

• Confirm the number of people in your household who receive more than 50% of their support from you
• Confirm how many of these people are enrolled in college and taking at least six credit hours (or the equivalent)

Instructions

1. Complete the form in its entirety.
2. Provide the requested tax and enrollment information.
3. Sign and date the form.
4. Submit the form within 30 days (but no later than April 1).

October Verification Form

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant recipient whose:

• Application was processed using a previously submitted Reduced Income Form

Use this form to:

• Update your family's estimate of their income so we can determine your final terms of aid

Instructions

1. Complete the form in its entirety.
2. Sign and date the form.
3. Submit the form within 30 days (but no later than April 1).

NOTE: If there is a significant discrepancy, you may need to repay some of your State Grant funds.

Untaxed Income Verification Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant who:

• Needs to clarify or update your family's untaxed income that should have been reported on the FAFSA (Free Application for Federal Student Aid)

Use this form to:

• Report your family's untaxed income

Instructions

1. Complete the form in its entirety.
2. Provide the requested tax information.
3. Sign and date the form.
4. Submit the form within 30 days (but no later than April 1).

Additional Financial Information Clarification Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant who:

• Must confirm or needs to make updates to this section of the FAFSA (Free Application for Federal Student Aid)

Use this form to:

• Update or correct the answers that you provided in the Additional Financial Information section of the FAFSA

Instructions

1. Complete the form in its entirety.
2. Sign and date the form.
3. Provide the requested tax information.
4. Submit the form within 30 days (but no later than April 1).

Active Duty Military/Veteran Clarification Form

Fall 2013 or Winter/Spring 2014 (PDF)

If you are:
A State Grant applicant who:

• Meets the eligibility requirements to be considered a Veteran applicant in the State Grant Program or
• Does not meet the Veteran eligibility requirements but is currently serving on active duty in the U.S. Armed Services for other than training

Use this form to:

• Update or correct your Active Duty Military/Veteran Status

Instructions

1. Complete the form in its entirety.
2. Sign and date the form.
3. Provide a copy of your DD214 Form.
4. Submit the form within 30 days (but no later than April 1).

Asset Clarification Form

Fall 2013 or Winter/Spring 2014 (PDF)

If you are:
A State Grant applicant who:

• Must confirm or needs to make updates to this section of the FAFSA

Use this form to:

• Update or correct the answers that you provided in the Student/Spouse asset section of the FAFSA, ONLY if you were required to initially complete this section on the FAFSA

Instructions:

1. Complete the form in its entirety.
2. Sign and date the form.
3. Provide the requested tax information and asset verification.
4. Submit the form and documents with 30 days (but no later than April 1).

If you are:
A State Grant applicant who:

• Didn't complete the Pennsylvania State Grant Form, click on the Apply Now button in the left column.

To complete the process, be sure to:

1. Sign the last page will all required signatures

2. Mail the completed signature page ONLY to:

   PHEAA
   State Grant and Special Programs
   P.O. Box 8157
   Harrisburg, PA 17105-8157

If you are:
A State Grant applicant who:

• Was directed by PHEAA to fill out this form

Instructions

1. View your incomplete items:
   • Sign in to Account Access.
   • Select "Complete the PA State Grant Form".
2. Provide only the missing items on the status notice. (Do not fill out the entire notice.)
3. Sign the form and have at least one parent whose information is reported on the form sign and date the form.
4. Submit pages 1 and 2 of the status notice. (We do not need you to return the instructions.)
5. Keep the Rights and Responsibilities Certification Document in your family's personal records.

Reduced Income Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant whose:

• Family income has decreased in comparison to the income that you reported on the FAFSA (Free Application for Federal Student Aid)

Use this form to:
Report reduced income due to one of the following:

• Recent job loss or change (supporting parent or stepparent) of at least 2 full months
• Recent retirement (supporting parent or stepparent)
• Recent permanent and total disability (supporting parent or stepparent)
• Recent death (supporting parent or stepparent)

Instructions

1. Complete the form in its entirety.
2. Provide the requested tax information.
3. Sign the form and have at least one parent whose information is reported on the form sign and date the form.
4. Submit the form no later than
   April 1.

Income Validation Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant whose:

• State Grant application was selected for Income Validation Review

Use this form to:
Supply any requested documentation (for your supporting parent or stepparent), including:

• U.S. Income Tax Returns
• W-2 Forms
• 1099 Forms
• Other tax-related information

Instructions

1. Gather the requested documentation.
2. Submit the form and documentation within 30 days (but no later than April 1).

Estimated Income Validation Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant whose State Grant application was selected for Income Validation Review because your supporting parent or stepparent either:

• Provided estimated family income on the FAFSA (Free Application for Federal Student Aid)
• Hasn't yet filed a tax return with the IRS

Use this form to:
Supply any requested documentation (for your supporting parent or stepparent), including:

• U.S. Income Tax Returns
• W-2 Forms
• 1099 Forms
• Other tax-related information

Instructions

1. Gather the requested documentation.
2. Submit the form and documentation within 30 days (but no later than April 1).

Recent Separation/Divorce Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant whose parents or supporting parent and stepparent either:

• Has been separated or divorced for at least 2 full months since the time you applied
• Was separated or divorced before you applied, but you incorrectly reported joint information

Use this form to:

• Report the family's adjusted income as a result of the separation or divorce (must be separated or divorced for at least 2 full months)

Instructions

1. Complete the form in its entirety.
2. Provide the requested tax information.
3. Sign the form and have at least one parent whose information is reported on the form sign and date the form.
4. Submit the form within 30 days (but no later than April 1) after the 2-month requirement is met.

Medical/Dental Expense Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant whose:

• Family paid extraordinary, out-of-pocket, unreimbursed medical or dental expenses during the year for which information is requested on the FAFSA (Free Application for Federal Student Aid)

Use this form to:

• Request reconsideration of your State Grant application

Instructions

1. Complete the form in its entirety.
2. Provide the requested tax information and documentation.
3. Sign the form and have at least one parent whose information is reported on the form sign and date the form.
4. Submit the form no later than
   April 1.

Family Size and Number Enrolled Clarification Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant who must confirm:

• The number of people in the household
• The number of people in the household attending college

Use this form to:

• Confirm the number of people in your household who receive more than 50% of their support from one or both parents or a parent and stepparent
• Confirm how many of these people are enrolled in college and taking at least six credit hours (or the equivalent)

Instructions

1. Complete the form in its entirety.
2. Provide the requested tax information.
3. Sign the form and have at least one parent whose information is reported on the form sign and date the form.
4. Submit the form within 30 days (but no later than April 1).

October Verification Form

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant recipient whose:

• Application was processed using a previously submitted Reduced Income Form

Use this form to:

• Update your family's estimate of their income so we can determine your final terms of aid

Instructions

1. Complete the form in its entirety.
2. Sign the form and have at least one parent whose information is reported on the form sign and date the form.
3. Submit the form within 30 days (but no later than April 1).

NOTE: If there is a significant discrepancy, you may need to repay some of your State Grant funds.

Untaxed Income Verification Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant who:

• Needs to clarify or update your family's untaxed income that should have been reported on the FAFSA (Free Application for Federal Student Aid)

Use this form to:

• Report your family's untaxed income

Instructions

1. Complete the form in its entirety.
2. Provide the requested tax information.
3. Sign the form and have at least one parent whose information is reported on the form sign and date the form.
4. Submit the form within 30 days (but no later than April 1).

Additional Financial Information Clarification Form

Fall 2013 or Winter/Spring 2014 (PDF)

Fall 2012 or Winter/Spring 2013 (PDF)

If you are:
A State Grant applicant who:

• Must confirm for us or needs to update your family's additional financial information that you reported on the FAFSA (Free Application for Federal Student Aid)

Use this form to:

• Update or correct the answers that you provided in the Additional Financial Information section of the FAFSA

Instructions

1. Complete the form.
2. Provide the requested tax information.
3. Sign the form and have at least one parent whose information is reported on the form sign and date the form.
4. Submit the form within 30 days (but no later than April 1).

Asset Clarification Form

Fall 2013 or Winter/Spring 2014 (PDF)

If you are:
A State Grant applicant who:

• Must confirm or needs to make updates to this section of the FAFSA

Use this form to:

• Update or correct the answers that your family provided in the parental asset section of the FAFSA, ONLY if your family was required to initially complete this section of the FAFSA

Instructions

1. Complete the form in its entirety.
2. Sign and date the form.
3. Provide the requested tax information and asset verification.
4. Submit the form and the requested documentation within 30 days (but no later than April 1).