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Student ID:

Student’s Name: (Legal full-name) Last First M.I.

Date Received:

Date Scanned:

Received By Method:

TASFA

2019-2020

APPLICATION

V03.18.2019 Page 2 of 18

STATEMENT OF STUDENT ELIGIBILITY 2019-2020

For assistance completing this form contact the Financial Aid Contact

Center at (281)290-2700.

Student ID: Student’s Name: Last First M.I.

Date of Birth: Phone: LSC E-mail: Month Day Year

STUDENT DATA

Have you ever been convicted of a felony or an offense under Chapter 481, Health and Safety Code (Texas Controlled Substances Act), or under the law

of another jurisdiction involving a controlled substance as defined by Chapter 481, Health and Safety Code?

YES* NO**

Note:

*If your answer is yes, please contact the Financial Aid Office to determine your Texas Educational Opportunity Grant (TEOG) eligibility.

**If your answer is no, it is your responsibility to inform the Financial Aid Office if this status changes at any time while attending the institution.

REFERENCE: STATUTORY PROGRAM RESTRICTIONS

A person is not eligible to receive an initial or renewal Texas Educational Opportunity Grant (TEOG)…

“…if the person has been convicted of a felony or an offense under Chapter 481, Health and Safety Code (Texas Controlled Subs tances Act), or under

the law of another jurisdiction involving a controlled substance as defined by Chapter 481, Health and Safety Code, unless the person has met the other

applicable eligibility requirements under this subchapter and has:

1. received a certificate of discharge by the Texas Department of Criminal Justice or a correctional facility or completed a period of probation

ordered by a court, and at least two years have elapsed from the date of the receipt or completion; or

2. been pardoned, had the record of the offense expunged from the person’s record, or otherwise has been released from the ineligibility to

receive a grant under this subchapter.”

Citations:

TEXAS Grant: Initial Awards TEC 56.304(b) Renewal Awards TEC 56.305(b) TEOG Grant: Initial Awards TEC 56.404(b) Renewal Awards TEC

56.305(b)

CERTIFICATION

I, , hereby certify that the information I have provided in this statement is true and

correct. I understand that if I fail to provide accurate information, I may be required to reimburse the institution and penalties may be imposed. I also

understand that it is my responsibility to inform the Financial Aid Office if my status concerning this statement of eligibility changes at any time while

attending this institution.

Student Signature: Date:

Section I: Health and Safety Code Chapter 481 Information Verification

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Please return this completed form to your nearest campus:

LSC-CyFair Financial Aid Office/CASA 105

9191 Barker Cypress Road Cypress, TX 77433-1383

LSC–North Harris Financial Aid Office/SSB 102 or 101

2700 W.W. Thorne Drive Houston, TX 77073-3499

LSC–Kingwood Financial Aid Office/SCC 134

20000 Kingwood Drive Kingwood, TX 77339-3801

LSC–Tomball Financial Aid Office/South Building-S114

30555 Tomball Parkway Tomball, TX 77375-4036

LSC–Montgomery Financial Aid Office/Building C-105

3200 College Park Drive Conroe, TX 77384-4500

LSC–University Park Financial Aid Office/Building 12 Suite 233A

20515 SH 249 Houston, TX 77070

Student ID: Student’s Name: Last First M.I.

CERTIFICATION

I, , hereby certify that the selective service status provided is true and correct. I

understand that I must provide documentation if requested by my institution that I may be required to complete a new statement for each academic year

for continued eligibility.

Student Signature: Date:

REQUIRED STATEMENT OF SELECTIVE SERVICE STATUS

All Students must complete

Are you currently registered for Selective Service, as required by federal law?

Registered Not Registered Exempt

(Proof of registration required) (If you were born a female check) (Documentation required)

Section II: Verification of Selective Service Registration

TO BE COMPLETED BY FINANCIAL AID DEPARTMENT

I have reviewed the information provided above and all information is complete.

School Official Printed Name:

School Official Signature: Date:

STATE OF TEXAS ELIGIBILITY: DRUG CONVICTION INFORMATION

Students who have been convicted of possessing or selling illegal drugs while receiving Texas State Aid may have their

eligibility for Texas State Aid suspended. Students who have a drug conviction should still complete the Texas

Application for State Financial Aid (TASFA). Some students with a drug conviction are ineligible for Texas State Aid for a

period of time and some are not. Even if a student is ineligible for Texas State Aid, he or she may still be eligible for

other funds.

Lone Star College is required to collect a statement from each TEOG recipient prior to the disbursement of funds

confirming eligibility in regard to the controlled substance restrictions of the program.

This statement must be retained with the student’s records at the institution and be made available if requested in the

course of a program review or audit. Each statement collected must be retained with the student’s records for 7 years

after the date of completion for the applicable award period (See TAC, Section 22.4(a)(2)(A)).

Lone Star College requires all TEOG recipients to complete the statement every year they receive a TEOG award. By

signing the document above, the student agrees that it is his/her responsibility to inform the institution if his/her status

changes in the future.

Reference: Statutory Program Restrictions A person is not eligible to receive an initial (IY) or a continuation grant (RY) “if the person has been convicted of a

felony or an offense under Chapter 481, Health and Safety Code (Texas Controlled Substances Act), or under the law of

another jurisdiction involving a controlled substance as defined by Chapter 481, Health and Safety Code, unless the

person has met the other applicable eligibility requirements under this subchapter and has the following items found in

the Regaining Eligibility section.”

"Controlled substance" means a substance, including a drug, an adulterant, and a dilutant, listed in Schedules I through

V or Penalty Group 1, 1-A, 2, 2-A, 3, or 4”

It is the student’s responsibility to self certify if any of the above applies. For information on what is needed, see reverse

side.

Regaining Eligibility

Earlier it was mentioned that a person is not eligible for the Texas Educational Opportunity Grant Program (TEOG)

“unless the person has met the other applicable eligibility requires under this subchapter and has:

(1) Received a certificate of discharge by the Texas Department of Criminal Justice or a correctional facility or completed

a period of probation ordered by a court, and at least two years have elapsed from the date of the receipt or

completion; or

(2) Been pardoned, had the record of the offense expunged from the person’s record, or otherwise has been released

from the resulting ineligibility to receive a grant under this subchapter.”

Citations: TEXAS Grant Initial Awards TEC 56.304(b) Renewal awards TEC 56.305(b) V03.29.2019 Page 4 of 18

STATE OF TEXAS ELIGIBILITY: DRUG CONVICTION INFORMATION

The following is a brief description of the controlled substance schedules and examples of their corresponding drugs:

For detailed information about the Schedules of Controlled Substances see: https://www.dshs.texas.gov/uploadedFiles/

Content/Regulatory/drugs/PDF/schedules/TR%20Final%202-2-2018.pdf

Texas law classifies drugs into certain penalty groups. The severity of the crime depends upon the amount or weight of the

drug, as well as other factors such as evidence of paraphernalia, money, and how the drug was stored. Penalties can be

enhanced if a person has prior criminal history. The classification of drugs and narcotics is defined in the Texas Controlled

Substances Act, found in the Texas Health and Safety Code. The following are the drug penalty groups and their most

common associated drugs:

Penalty Group 1: cocaine, heroin, methamphetamine, morphine, and oxycodone;

Penalty Group 1A: LSD;

Penalty Group 2: Ecstasy, PCP, and hallucinogens;

Penalty Group 2A: synthetic marijuana;

Penalty Group 3: Xanax, Valium, Ritalin;

Penalty Group 4: various components and mixtures containing limited narcotics.

For detailed information about the Chapter 481, Health and Safety Code (Texas Controlled Substances Act) see: https://statutes.capitol.texas.gov/Docs/HS/pdf/HS.481.pdf

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Schedule Description Examples

I

Substances have no currently accepted medical use in the United States, a

lack of accepted safety for use under medical supervision and a high

potential for abuse.

heroin, LSD, marijuana (cannabis), peyote (mescaline),

methaqualone (Quaalude),

3,4methylenedioxymethamphetamine (“ecstasy”) and

“bath salts.”

II

Substances in this schedule have a high potential for abuse which may lead

to severe psychological or physical dependence.

NARCOTIC:

hydromorphone (Dilaudid),

methadone (Dolophine),

meperidine (Demerol),

oxycodone (OxyContin,

Percocet), and fentanyl

(Sublimaze)

NON-NARCOTIC:

amphetamine (Dexedrine,

Adderall),

methamphetamine

(Desoxyn), and

methylphenidate (Ritalin)

III

Substances in this schedule have a potential for abuse less than substances

in Schedules I or II and abuse may lead to moderate or low physical

dependence or high psychological dependence

NARCOTIC:

combination products

containing less than 15 mgs

of hydrocodone per dosage

unit (Vicodin), products

containing not more than 90

mgs of codeine per dosage

unit (Tylenol with codeine),

and buprenorphine

NON-NARCOTIC:

benzphetamine (Didrex),

phendimetrazine,

ketamine, and anabolic

steroids such as

DepoTestosterone.

IV

Substances in this schedule have a low potential for abuse relative to

substances in Schedule III.

alprazolam (Xanax), carisoprodol (Soma), clonazepam

(Klonopin), clorazepate (Tranxene), diazepam (Valium),

lorazepam (Ativan), midazolam (Versed), temazepam

(Restoril), and triazolam (Halcion).

I

Substances in this schedule have a low potential for abuse relative to

substances listed in Schedule IV and consist primarily of preparations

containing limited quantities of certain narcotics.

cough preparations containing not more than 200

milligrams of codeine per 100 milliliters or per 100 grams

(Robitussin AC, Phenergan with Codeine), and ezogabine.

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TASFA CHECKLIST 2019-2020

For assistance completing this form contact the

Financial Aid Contact Center at (281)290-2700.

House Bill 1403/Senate Bill 1528 only: House Bill 1403 from the 2001 Legislative Session/Senate Bill 1528 from the 2005 State Legislative

Session allows certain categories of foreign-born and immigrant students in the State of Texas to qualify for residency under Texas Education Code

Chapter 54, Section 54.052(a)(3). This state law allows such students to pay the resident tuition rate while attending public institutions of higher

education in Texas, and be classified as state residents for tuition purposes. As Texas residents, such students are eligible to apply for some student

financial aid programs offered by the State of Texas.

Student ID: Student’s Name: Last First M.I.

Date of Birth: Phone: LSC E-mail: Month Day Year

TEOG ELIGIBILITY REQUIREMENTS

For complete eligibility requirements please visit www.collegeforalltexans.com.

Are Texas residents for 3 years prior to graduation and graduated from an accredited high school in Texas

(not earlier than 1998-1999 school year).

Have not been convicted of a felony or crime involving a controlled substance.

Demonstrates financial need.

Have an EFC less than or equal to $5,875.

Register for Selective Service or be exempt from this requirement.

Must meet the State Standards of Academic Progress (SAP).

See link above for requirements

Continuing recipients must meet minimum requirements set by THECB.

Must not have earned an associate or baccalaureate degree. Be enrolled at least 1/2 time in an undergraduate

degree or certificate program, at a 2 year institution. Must not have attempted more than 30 semester credit hours

(SCH). (excluding credits for dual enrollment or by examination). (For Initial Only)

CERTIFICATION

I certify that the information provided herein is true and correct to the best of my knowledge. I also understand that if I p urposely give

false or misleading information in connection with my application for federal aid, I may be subject to a fine of up to $20,00 0, sent to

prison, or both.

Student Signature: Date:

Please return this completed form to your nearest campus:

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LSC-CyFair Financial Aid Office/CASA 105

9191 Barker Cypress Road Cypress, TX 77433-1383

LSC–North Harris Financial Aid Office/SSB 102 or 101

2700 W.W. Thorne Drive Houston, TX 77073-3499

LSC–Kingwood Financial Aid Office/SCC 134

20000 Kingwood Drive Kingwood, TX 77339-3801

LSC–Tomball Financial Aid Office/South Building-S114

30555 Tomball Parkway

LSC–Montgomery Financial Aid Office/Building C-105

3200 College Park Drive

LSC–University Park Financial Aid Office/Building 12 Suite 233A

20515 SH 249

Student ID: Student’s Name: Last First M.I.

If you require assistance or have questions concerning your application, please visit the Lone Star College Financial Aid

Department. Completed TASFAs will be processed within 7 - 10 business days. If you do not receive notification after 10

business days, please contact the Financial Aid Office to check on the status of your application.

REQUIRED DOCUMENTS CHECKLIST (COMPLETED BY FINANCIAL AID DEPARTMENT)

All items must be submitted each year you apply to determine financial aid eligibility.

Final Official High School Transcripts and SB 1528

Affidavit

On-File With Admissions Date Reviewed:

Parent’s Tax Return Transcript/IRS Verification Letter

of Non-Filing IRS Request Date:

Proof of Identity:

See Proof of Identity page in the TASFA packet for a list of acceptable ID:

if unable to provide ID see your Financial Aid Department.

Selective Service Registration (https://www.sss.gov/)

Males between the ages of 18 and 25, must register with the

Selective Service.

Date of Registration:

TASFA Application with Statement of Student Eligibility

Residency:

Student Tax Return Transcript/IRS Verification Letter of

Non-Filing IRS Request Date:

If student is a dependent, Letter of Non-filing is not required.

Did the student previously receive the Texas Grant at

another institution?

Driver License Texas State ID

Foreign Passport Visa

Matrícula Consular Employment Authorization

Card

INTL ID A INTL ID B

INTL OD A INTL OD B

Yes No

TO BE COMPLETED BY FINANCIAL AID DEPARTMENT

I have reviewed the information provided above and all information is complete.

School Official Printed Name:

School Official Signature: Date:

Student’s ID’s must use legal full-name to match TASFA and Admissions records. ID’s are not

acceptable if legal full-name is not used. Below are acceptable forms of identification, check the

appropriate box below.

Proof of Identity

Yes, check if none of these options are applicable. Please visit your Financial Aid Office.

Texas Driver License/Texas State ID

Foreign Passport

(can be expired)

Visa

Matrícula Consular

Employment Authorization Card

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Yes No

Yes No

Yes No

Yes No

Yes No

HOW TO ORDER TRANSCRIPTS

FORM 4506-T

Paper form submitted via postal mail

Located on IRS website or in the Financial Aid Office

Will receive in 5-10 business days to address on record

If transcript is mailed to a 3rd party must include a specific

address on line 5

Toll Free Telephone Line

1-800-908-9946

Transcripts will only be mailed

Will receive in 5-10 business days to address on record

IRS Website

http://www.irs.gov/Individuals/Get-Transcript

Immediate delivery in PDF format

Must have one of the following:

Credit Card (will not be charged)

Mortgage or Home Equity Loan

Home Equity Line of Credit

Auto Loan

Mobile Phone account in your name

Transcripts that can be requested online:

Return Transcript

Record of Account Transcript

Account Transcript

Wage & Income Transcript

http://www.irs.gov/Individuals/Get-Transcript

Important Information

Walk-Ins

The IRS office will no longer

accept walk-in customers, must

make an appointment which

takes 4-5 weeks.

Mailed Transcripts 5-10 business days to receive

a requested transcript by USPS

mail.

Third Party requests

Transcripts that are mailed to

another party should be

requested using the 4506-T

form.

IRS Website

Must have a valid credit card,

can not use a pre-paid card or

debit card.

If your mobile phone can’t be

verified:

Alternate verification options

will be sent and will take

additional 5-10 business days.

Moved?

If you moved since your taxes

were filed you must request

transcripts using 4506-T form.

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HOW TO REGISTER FOR

SELECTIVE SERVICE

ONLINE

The easiest and fastest way for a man to register is to register online.

Men, age 18 through 25, living in the United States, with a social

security number, can register online at:

https://www.sss.gov/Registration/Register-Now/Registration-Form

POST OFFICE

If you cannot register online because there is an error with your social

security number, or you are an immigrant male, Selective Service

“mail-back” registration forms are available at any U.S. Post Office.

A man can fill it out, sign (leaving the space for his Social Security

Number blank, if he has not yet obtained one*), affix postage, and

mail it to Selective Service, without the involvement of the postal clerk.

Men living overseas may register at any U.S. Embassy or consular

office.

*Provide your Social Security Number to the Selective Service when

you do obtain one.

HIGH SCHOOL

More than half the high schools in the nation have a staff member or

teacher appointed as a Selective Service Registrar. These individuals

help register male high school students.

Important Information

ONLINE

Men, age 18 through 25,

living in the United States,

must have a social security

number.

Register online at:

https://www.sss.gov/

Registration/Register-Now/

Registration-Form

POST OFFICE

Mail your registration form to:

Selective Service System

P.O. Box 94739

Palatine, IL 60094-4739

If your Registration

Acknowledgement is not

received within 90 days, you

must contact the Selective

Service System at the

following Address:

Selective Service System

Registration Information Office

P.O. Box 94638 Palatine, IL

60094-4638

HIGH SCHOOL

See your high schools

Selective Service Registrar.

1-888-655-1825 https://www.sss.gov/

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