Dc osse non disclosure agreement affirmation form

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LEGAL DISCLAIMER

OSSE uses the information provided in the DC OneApp application to determine if the student is eligible to receive student financial aid. Sections 3(e) and 5(d) of the District of Columbia College Access Act of 1999, as amended (Pub. L. No. 106-98; D.C. Official Code §§ 38-2702(e) and 38-2704(d) authorize OSSE to ask the student and the student’s parents, legal guardians, or other person providing more than 50 percent of financial assistance the questions provided in the application, and to request a Social Security Number to verify identity and retrieve any records to help us determine eligibility for any and all DC Grants for which the student is applying.

All DC OneApp applicants must provide the Applicant Affirmation Statement below. Further, all applicants and individuals through which the student is establishing District of Columbia domicile must sign this consent to share information for limited purpose. Finally, all parents, guardians, spouses or other persons that (1) provide more than 50 percent of the applicant’s financial support of dependent DC OneApp applicants; and (2) are domiciled in the District of Columbia must sign and date the Provider of Financial Support Affirmation Statement.

Applicant Affirmation Statement

I do hereby affirm the following:

1. I am domiciled in the District of Columbia.
2. I have not received my first undergraduate baccalaureate degree.
3. I am not enrolled in a graduate or professional degree program.
4. I am not in default on any loans Title IV of the Higher Education Act of 1965, and I do not owe a refund for funds previously received under Title IV; or I have made satisfactory arrangements for repayment.
5. If I am a male 18-25 years of age, I have either registered with Selective Service or provided documentation that complies with the rules justifying my non-registration with Selective Service.
6. All information provided on this form and the attachments is accurate, complete and true to the best of my knowledge.
7. I understand that I have an affirmative responsibility to inform the Office of the State Superintendent of Education (OSSE) of any changes to the information provided in this form and the attachments, including changes to my place of domicile, income, tax information, or Student Aid Report (SAR).
8. I understand that knowingly providing false information may disqualify my DC OneApp application from consideration and may make me subject to fines or imprisonment in accordance with Federal and District of Columbia laws.

Consent to Share Information for Limited Purpose

Your signature below gives your consent to authorize OSSE’s’ re-disclosure of the following information provided to it by an institution of higher education:

• Information designated as “directory information” by the institution of higher education, which may include the student's name, address, telephone number, date and place of birth, honors and awards, and dates of participation in financial assistance programs;
• Enrollment information, which may include the student’s credit hours, enrollment status, year in college, degree sought, dependency status, cumulative GPA, whether the student is achieving satisfactory academic progress, and the student’s first year in college;
• Tuition costs; and
• Total amount of financial aid awarded.

Additionally, your signature below gives your consent to authorize OSSE’s disclosure of any information on the DC OneApp application, including family history, academic history, and contact information of the student and/or parent/legal guardian, or other individual through which District domicile is established.

The purpose of disclosing the above information is to verify a student’s identity and application, enrollment, payment, eligibility, or residency status with certain third parties. The third parties to whom OSSE may disclose the above data include local education agencies at which the student previously enrolled, local scholarship organizations, a student’s parents, legal guardians, and/or other family members, colleges or universities to which the student has applied for admission or in which the student is enrolled. OSSE may also provide the above information provided as part of the DC OneApp application to certain third parties OSSE has authorized to assist in administering the programs for which the student has applied through submission of the online DC OneApp.

I understand that by signing this statement, I am also verifying the accuracy of the completed DC OneApp application and giving the District of Columbia permission to verify any information provided. I further agree to provide information that will verify the accuracy of the completed DC OneApp application, if requested. This information may include my Federal or DC or other state income tax returns. Also, I certify that I understand that a representative of OSSE has the authority to verify information reported on my DC OneApp with the DC Office of Tax and Revenue and other federal or local agencies. If I purposely give false or misleading information at any point in the application process, I may be subject to penalties or fines. (D.C. Code §2-381.02)

My signature below authorizes OSSE, on behalf of the District of Columbia, to have full and complete access to the student’s academic, financial and enrollment records at the college/university the student attends or will attend. This is being done to assist in the successful completion of the student’s undergraduate education.