15CV4 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
Please answer all questions below.
In 2013 or 2014, 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
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
Student/Spouse Parent None
Student/Spouse Parent None
All address and phone number
corrections should be made on
WebAdvisor.
Office Use Only: Dep ____Ind____Initial____
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
2015-2016
V4 Custom
Verification Worksheet
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
