2014–2015
Verification of Food Stamps
A. Student’s Information
________________________________ _____________________________________ ___________________
Student’s Last Name Student’s First Name Student #
____________________________________________ _________________________________________
Student’s Email Address Student’s Phone Number (include area code)
B. Verification of Food Stamps
Check the box below if someone in your household (For Independent Students) received benefits from
the Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) any
time during the 2012 or 2013 calendar years.
Someone in my household received SNAP benefits in 2012 or 2013.
The student’s household includes the following:
The student
The student’s spouse, if the student is married.
The student’s or spouse’s children if the student or spouse will provide more than half of their support from July 1, 2014
through June 30, 2015, even if the children do not live with the student.
Other people if they now live with the student and the student or spouse provides more than half of their support and
will continue to provide more than half of their support through June 30, 2015.
Check the box below if someone in your parent’s household (For Dependent Students) received
benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as food
stamps) any time during the 2012 or 2013 calendar years.
Someone in my parent’s household received SNAP benefits in 2012 or 2013.
The parent’s household includes the following:
The student
The parents (including a stepparent) even if the student doesn’t live with the parents..
The parent’s other children if the parents will provide more than half of their support from July 1, 2014 through June 30,
2015, or if the other children would be required to provide parental information if they were completing a FAFSA for
2014-2015. Include children who meet either of these standards even if the children do not live with the parents.
Other people if they now live with the parents and the parents provide more than half of their support and will continue
to provide more than half of their support through June 30, 2015.
Note: If we have reason to believe that the information regarding the receipt of SNAP benefits is inaccurate, we may require
documentation from the agency that issued the SNAP benefits in 2012 or 2013.
SNAP may be known by another name in some states. For assistance in determining the name used in a state, please call
1(800) 4FED-AID (1-800-433-3242).
C. Certification and Signatures
Each person signing this worksheet certifies that all of the information reported is complete and
correct. The student and one parent (if dependent) must sign and date.
_________________________________________________ _________________________________
Student’s Signature Date
_________________________________________________ _________________________________
Parent’s Signature (Required for dependent students) Date
Your 2014–2015 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. We will compare your FAFSA with the
information on this worksheet. If there are differences, your FAFSA information may need to be corrected. You and at least one parent must complete and sign this
worksheet if dependent, attach any required documents, and submit this form and other required documents to the Financial Aid Office.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
