California State University, Sacramento Financial Aid & Scholarships Office 6000 J Street • Sacramento, CA 95819-6044 T (916) 278-1000 • F (916) 278-6082

FINANCIAL AID AWARD & ENROLLMENT FORMComplete and submit this form to verify your financial aid award, cost of attendance and enrollment status to your designated third party. Completed form can be submitted by any of the following:

• Use your CSUS email account and send to sacstatessc@csus.edu with “Financial Aid Verification” in the subject line• Mail form to the address listed at the top of the form

Once received, allow 5-7 business days for your request to be processed.NOTE: One copy is filed in the student’s school record and one copy is sent to the person/agency. The form is NOT returned to the student.

Third Party Release This section is completed by the student

Person/Agency Name: ______________________________________Address________________________________________________

Phone Number: _________________Fax Number: ________________Email Address:__________________________________________

I hereby authorize the Financial Aid & Scholarship Office at Sacramento State University to release my financial aid status and any other relevant information to the following person(s) or Agency.

Student Signature: ____________________________________ Date:_____________________

Financial Aid Verification This section is completed by the Financial Aid & Scholarship office

___This student has not applied for financial aid for the school year: _________________

___This student financial aid file was closed on ______________ for___________________________

___This student is not receiving aid for the following semester(s): ___Fall _________ ___Spring _________ ___Summer _________

___This student is receiving/scheduled to receive aid for the following period(s):

___Fall 2020 to Spring 2021: (8/21/20-5/14/21) ___Spring 2021: (1/25/21-5/14/21)

___Fall 2020: (8/21/20-12/11/20) ___Summer 2021: (5/24/21-8/20/21)

Grants Offer Paid Period Loans/Other Offer Paid PeriodFederal Pell Grant Federal Perkins Loan

Federal SEOG Grant Direct Subsidized Loan

Educational Opp. Grant Direct Unsubsidized Loan

State Univ. Grant Parent/Grad PLUS Loan

Cal Grant A / B / SWD Other:

Total Total

Cost of Attendance (Student Budget) All financial aid awarded at Sacramento State is intended to meet the educational costs associated to the student.

Details on our Award Notification Guide.

Program Status: ___Undergraduate ___Graduate ___Doctorate ___Teaching Credential

Enrollment Status: Fall 2020 _________ Spring 2021 _________ Summer 2021 _________

Expected Date of Graduation: __________________

Costs With Parent On-Campus Off-Campus Other

Books/Supplies

*Fees

Food/Housing

Loan Fees

Misc./Personal

Non-Resident Tuition

Transportation

Total

*Graduate students add $1506 for graduate registration fees; Teaching Credential students add $1398. State-supported MBA students add $270 per unit for graduate business professional fee. Non-resident students add $396 per unit for non-resident registration fees. The CSU makes every effort to keep student costs to a minimum. Fees listed in published schedules or student accounts may need to be increased when public funding is inadequate. Therefore, the CSU must reserve the right, even after initial fee payments are made, to increase or modify any listed fees, without notice, until the date when instruction for a particular semester or quarter has begun. All CSU listed fees should be regarded as estimates that are subject to change upon approval by the Board of Trustees.

Request completed by _________________________ Staff Signature_____________________________________ Date _______________

R:10/29/20 FILE 20/21

Student Name: _______________________

Sac State ID#: _______________________

(sending from your CSUS email is acceptable in lieu of signature)