print and clear
2008–2009
Financial Aid Office Drug Conviction Worksheet
University of California, Santa Cruz for FAFSA Question 31
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UCSC Student’s ID Number UCSC Student’s Last Name First Name
WOrkSheet FOr QUeStiOn 31
We sent you this worksheet because you left Question 31 blank on your FAFSA, or because you told us you have a drug-related conviction.
On this worksheet, count only federal or state convictions. Do not count any convictions that have been removed from your record, or
occurred before you turned 18, unless you were tried as an adult. Complete this worksheet, sign the certification at the end, and return this
document to the UCSC Financial Aid Office.
1. Have you ever been convicted of selling or possessing drugs (not including alcohol or tobacco)?
No If No, stop here. Sign the certification, and return this form.
Yes If Yes, go to question 2.
2. Did the offense for possessing or selling illegal drugs occur during a period of enrollment for which you were receiving federal
student aid (grants, loans, and/or workstudy)?
No If No, stop here. Sign the certification, and return this form.
Yes If Yes, go to question 3.
3. Have you completed an acceptable drug rehabilitation program since your conviction? An acceptable drug rehabilitation pro-
gram must include at least two unannounced drug tests, and: be qualified to receive funds from a federal, state or local govern-
ment or court, or from a federally or state-licensed insurance company; or be administered or recognized by a federal, state or
local government agency or court, or a federally or state-licensed hospital, health clinic or medical doctor.
Yes If Yes, stop here. Sign the certification, and return this form.
No If No, go to question 4.
4. Do you have more than two convictions for possessing illegal drugs? Only count convictions for offenses that occurred during a
period of enrollment for which you were receiving federal student aid (grants, loans, and/or work-study)?
Yes If Yes, you are not eligible for federal student aid for this school year unless
you completed an acceptable drug rehabilitation program. Even if you are
not eligible for federal student aid, you may still be eligible for state and
school aid.
No If No, go to question 5.
5. Do you have more than one conviction for selling illegal drugs? Only count convictions for offenses that occurred during a
period of enrollment for which you were receiving federal student aid (grants, loans, and/or work-study)?
Yes If Yes, you are not eligible for federal student aid for this school year unless
you completed an acceptable drug rehabilitation program. Even if you are
not eligible for federal student aid, you may still be eligible for state and
school aid.
No If No, go to question 6.
Continued on next page. F9DRUG
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UCSC Student’s ID Number UCSC Student’s Last Name First Name
6. Write the date of your last conviction for possessing illegal drugs here: 6 / /
If you have no convictions for possessing drugs, skip to question 8.
7. If you have only one conviction for possessing drugs, add one
year to the date in question 6, and write that date here: 7 / /
If you have two convictions for possessing drugs, add two years
to the date in question 6, and write that date here: / /
8. Write the date of your last conviction for selling drugs here: 8 / /
If you have no convictions for selling drugs, skip to question 10.
9. If you have only one conviction for selling drugs, add two years
to the date in question 8, and write that date here: 9 / /
10. Look at the dates you wrote in question 7 and 9. 10
• If there is only one date, copy that date here:
/ /
• If there are two dates, write the later one here:
your eligibility date
What to do with your eligibility date:
• If your eligibility date in question 10 is before July 1, 2008 sign the certification and return this form.
• If your eligibility date falls between July 1, 2008 and June 30, 2009 you should notify the Financial Aid Office of your eligibil-
ity date. You can become eligible earlier in the school year if you attend an acceptable drug rehab program. Even if you are not
eligible for federal student aid, you may still be eligible for state and other school aid.
• If your eligibility date is after June 30, 2009, you are not eligible for federal student aid for this school year unless you complete
an acceptable drug rehabilitation program. Even if you are not eligible for federal student aid, you may still be eligible for state
and school aid.
StUdent CertiFiCAtiOn
• I hereby declare that all information reported on this document is true, complete, and accurate to the best of my knowledge.
• I understand that any false statement or misrepresentation will be cause for denial, reduction, withdrawal and/or repayment of financial aid.
• For fall quarter admits and continuing students, this document must be postmarked by June 1, 2008 to be considered for all types of aid.
Choose one: As of the date of application, I was
Married/Remarried................. Divorced/Separated ...................... Month and year you
were married, separated,
divorced or widowed
Single ..................................... Widowed ...................................... Month Year
California Registered Domestic Partner .........
Daytime Phone ( ______ ) ______________________________ Email Address ______________________________________________
Student Signature ______________________________________________________ Date ___________________________________
retUrn tO: UCSC Financial Aid Office, 205 Hahn Student Services Building, 1156 High Street, Santa Cruz, CA 95064
Phone: (831) 459-2963 Web: http://www2.ucsc.edu/fin-aid/ For your protection and security, please do not email forms. F9DRUG