Fillable 2013 14 Dep V4 Worksheet (Golden Gate University)

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2013 14 Dep V4 Worksheet (Golden Gate University)

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2013–2014 Verification Worksheet
Dependent Student- Tracking Group V4
Your 2013–2014 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that
before awarding Federal Student Aid, we may ask you to confirm the information you and your parents reported on your FAFSA. To verify that
you provided correct information the financial aid administrator at your school will compare your FAFSA with the information on this worksheet
and with any other required documents. If there are differences, your FAFSA information may need to be corrected. You and at least one
parent must complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the
financial aid administrator at your school. Your school may ask for additional information. If you have questions about verification, contact your
financial aid administrator as soon as possible so that your financial aid will not be delayed.
A. Dependent Student’s Information
Student’s Last Name Student’s First Name Student’s M.I.
Student’s SSN or ID Number
Student’s Street Address (include apt. no.)
Student’s Date of Birth
City State Zip Code
Student’s Email Address
Student’s Home Phone Number (include area code)
Student’s Alternate or Cell Phone Number
B. Parent’s Other Information to Be Verified
1. Complete this section if someone in the student’s parent’s household (listed in Section B) received benefits from the Supplemental
Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2011 or 2012 calendar years.
One of the persons listed in Section B of this worksheet received SNAP benefits in 2011 or 2012. If asked by the student’s school, I will
provide documentation of the receipt of SNAP benefits during 2011 and/or 2012.
2. Complete this section if one of the student’s parents paid child support in 2012.
One (or both) of the student’s parents listed in Section B of this worksheet paid child support in 2012. The parent has indicated below
the name of the person who paid the child support, the name of the person to whom the child support was paid, the names of the
children for whom child support was paid, and the total annual amount of child support that was paid in 2012 for each child. If asked by
the school, I will provide documentation of the payment of child support. If you need more space, attach a separate page that includes
the student’s name and Social Security Number at the top.
Name of Person Who Paid
Child Support
Name of Person to Whom
Child Support was Paid
Name of Child for Whom Support
Was Paid
Amount of Child Support
Paid in 2012
Joe Jones Jane Doe Jake Jones $6,000
1
Student Name:
C. High School Completion Status
You must submit documentation of high school completion or an equivalent along with this worksheet.
Check the box of the document you will attach to this worksheet:
High school diploma or high school transcript including graduation date.
Official documentation from high school counselor stating your graduation date and reason why high school diploma/transcript is
unavailable.
General Education Development (GED) Certificate.
State certificate stating you have passed a State-authorized examination recognized as an equivalent of a high school diploma.
Academic transcript of a successfully completed two-year program acceptable for full credit toward a bachelor’s degree.
If you are a homeschooled student, a transcript or equivalent, signed by parent or guardian, listing secondary school courses you have
completed and documentation that you have successfully completed secondary school education.
If you are a homeschooled student, a secondary school completion credential provided under State law.
D. Documentation of Identity/Statement of Educational Purpose
In order to complete the Verification process, you will need to appear in person at your postsecondary institution and present your
government issued ID (such as a driver’s license, military ID, passport, etc.) and this verification worksheet to an institutionally authorized
financial aid administrator. Your financial aid administrator will need to validate the statement below at the time of submission by
maintaining a copy of your photo ID and by providing a signature and date. If you cannot appear in person to submit this worksheet, you
will need to provide a copy of your government issued ID and this worksheet notarized by a public notary.
Statement of Educational Purpose
I certify that I _____________________________ am the individual signing this Statement of Educational Purpose and that the federal
(Print Student’s Name)
student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending
_________________________________________ for 2013-2014.
(Name of Postsecondary Educational Institution)
Student’s Signature and Date
Financial Aid Administrator Signature and Date
Notary’s Certificate of Knowledge
State of
City/County of
on
before me,
personally appeared,
(Notary’s Name)
(printed name of signer)
And provided to me on basis of satisfactory evidence of identification
(Type of government-issued photo ID provided)
To be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal
(Notary Signature)
(Date commission expires)
(seal)
2
Student Name:
E. Certification and Signatures
Each person signing this worksheet certifies that all of the information reported on it is complete and correct. The student and one parent
must sign and date.
Student’s Signature
Date
Parent’s Signature
Date
Do not mail this worksheet to the U.S. Department of Education.
Submit this worksheet to the financial aid administrator at your school.
You should make a copy of this worksheet for your records.
WARNING: If you purposely give false or misleading Information on this
worksheet, you may be fined, be sentenced to jail, or both.
3
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2013 14 Dep V4 Worksheet (Golden Gate University)

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Completed 20 July 2020

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