15CV1.5 2/18/15
Your application was selected for review in a process called “Verification”. When a student’s file is selected for
verification, the Financial Aid Office must document and validate certain data elements from the FAFSA. The
law says we must ask you for additional information before awarding Federal Aid and Maryland Grants or
Scholarships. If there are differences between your application information and your financial documents, the
Financial Aid Office may need to make corrections electronically, and you may receive a corrected Student Aid
Report (SAR).
Instructions:
Complete all pages of this verification form and submit it to HCC Student Financial Aid Office as
soon as possible, so that your financial aid won’t be delayed. Please contact us if you need any additional
information to fill out this form.
Student Information
__________________________________________________
Last Name First Name MI
________________________________
HCC ID Number
Household Information
Fill in the chart on the next page after making a selection below:
I am a DEPENDENT student. My household will include:
Yourself.
Your parents (including a stepparent) even if you don’t live with your parents.
Your parents’ other children (Siblings) if your parents will provide more than half of the children’s
support from July 1, 2015, through June 30, 2016, or if the other children would be required to
provide parental information if they were completing a FAFSA for 2015–2016. 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 the other
people’s support and will continue to provide more than half of their support through June 30, 2016.
I am an INDEPENDENT student. My household will include:
Yourself.
Your spouse, if you are married.
Your children or your spouse’s children, if you or your spouse will provide more than half of the
children’s support from July 1, 2015, through June 30, 2016, even if the children do not live with
you.
Other people if they now live with you and you or your spouse provides more than half of the other
people’s support and will continue to provide more than half of their support through June 30, 2016.
All address and phone number
corrections should be made on
WebAdvisor.
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
2015 – 2016 V1/V5
Standard/Aggregate
Verification Worksheet
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both
.
15CV1.5 2/18/15
Please list the persons living in your household; include yourself on the top line.
If more space is needed, provide a separate page with the student’s name and ID number at the top.
Full Name Age Relationship
Attending College
6 credits or more? **
(example) Martha Jones 24 wife City University
Self
**Attending College: Include information about any household member, excluding the parents, who
will be enrolled at least half time in a degree, diploma, or certificate program at an eligible
postsecondary educational institution any time between July 1, 2015, and June 30, 2016, include the
name of the college.
Financial Information
Please answer the questions below.
In 2014 or 2015, did anyone in the household receive benefits from the Supplemental Nutrition
Assistance Program (SNAP) also known as Food Stamps?
In 2014 did anyone in the household PAY child support?
If yes – Complete the chart below.
(If you need more space, attach a separate page.)
Name of the person who
paid Child Support
Name of the child for whom
the support was paid
Age
Name of the person to whom
you paid the support.
Amount paid in
2014
Student/Spouse Parent None
Student/Spouse Parent None
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Asset InformationIndependent Students, enter N/A for Parents (*for help, see notes this page):
Student/Spouse
Parent As of today, what was your total current balance of cash, savings, and
checking accounts? Do not include student financial aid.
Enter Zero (0) if none.
Student/Spouse Parent As of today, what was the net worth of your investments, including real
estate (not your home)? See notes on bottom of form.
Enter Zero (0) if none.
Student/Spouse Parent As of today, what was the net worth of your current businesses and/or
family owned businesses and/or investment farms? Do not include a
farm that you live on and operate. See notes on bottom of form.
Enter Zero (0) if none.
By signing this form you are certifying that all the information reported on it is
complete and correct.
________________________________________________________________
Student Signature Date
________________________________________________________________
Parent Signature (required for dependent student) Date
*
Notes for Asset Questions
Net worth means current value minus debt. If net worth is negative, enter 0.
Investments include real estate (do not include the home in which yo
u live), rental property (includes a unit within a family home that
has its own entrance, kitchen, and bath rented to someone other than a family member) trust funds, UGMA and UTMA accounts,
money market funds, mutual funds, certificates of deposit, stocks, stock options, bonds, other securities, installment and land sale
contracts (including mortgages held), commodities, etc.
Investments also include qua
lified educational benefits or education savings accounts (e.g. Coverdell savings accounts, 529 college
savings plans and the refund value of 529 prepaid tuition plans). For a student who does not report parental information, the accounts,
owned by the student (and/or the student’s spouse) are reported as student investments. For a student who must report parental
information, the accounts are reported as parental investments, including all accounts owned by the student and all accounts owned
by the parents for any member of the household.
Investments do not include the home you live in, the value of life insurance, retirement plan
s (401[k] plans, pension funds, annuities,
non-education IRAs, Keogh plans, etc.) or cash, savings and checking accounts already reported as cash. Investments also do not
include UGMA and UTMA accounts for which you are the custodian, but not the owner.
Investment value means the current balance or market value of these investments as of the day you completed the FAFSA.
Investment debt means only those debts that are related to the investments.
Business and/or investment farm value includes the market value of land, buil
dings, machinery, equipment, inventory, etc. Business
and/or investment farm debt means only those debts for which the business or investment farm was used as collateral.
Business value does not include the value of a small business if your family
owns and controls more than 50 percent of the business
and the business has 100 or fewer full-time or full-time equivalent employees. For small business value, your family includes (1)
persons directly related to you, such as a parent, sister or cousin, or (2) persons who are or were related to you by marriage, such as
a spouse stepparent or sister-in-law.
Investment farm value does not include the value of a family farm that you (yur spouse and/or your parents) live on and operate.
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