Fillable 2014 15 Dep V4 Worksheet (Golden Gate University)

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2014 15 Dep V4 Worksheet (Golden Gate University)

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2014–2015 Verification W
o
r
ksh
ee
t
Dependent Student - Tracking Group V
4
Your 2014–2015 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 inf
ormation 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
MI
Student’s SSN or ID Number
Student’s Date of Birth
City
State
Zip
Student’s Email Address
Student’s Phone Number
Student’s Alternate or Cell Phone Number
Parent’s Other Information to Be Verified
B. Supplemental Nutritional Assistance Program
Check the appropriate box below:
No one listed in the household received SNAP benefits in 2012 or 2013.
One of the persons listed in the household received SNAP benefits in 2012 or 2013. If asked by the student’s school, I will provide
documentation of the receipt of SNAP benefits during 2012 and/or 2013.
C. Child support paid
Check the appropriate box below:
No child support was paid for individuals outside of the household in 2013.
One (or both) of the student’s parents, included in the household, paid child support in 2013. 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 2013 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 st
udent’s name and Social Security Number at the top.
Name of Person Who P
aid
Child
Suppo
r
t
Name of Person to W
ho
m
Child Support was P
aid
Name of Child for Whom
Suppo
r
t
Was P
aid
Amount of Child
Suppo
r
t
Paid in
2013
Joe Jones
Jane Doe
Jake Jones
$6,000
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.
A copy of the student’s General Educational Development (GED) certificate, an official GED transcript that indicates the student passed
the exam, or a state-authorized high school equivalent certificate
For students who completed secondary education in a foreign country, a copy of the “secondary school leaving certificate” or other
similar document.
Academic transcript of a successfully completed two-year program acceptable for full credit toward a bachelor’s degree.
Student Name:
Student ID Number:
______________________________ __________________________
For a homeschooled student from a state where state law requires the student to obtain a secondary school completion credential for
homeschool (other than a high school diploma or its recognized equivalent), a copy of that credential.
For a homeschooled student from a state where state law does not require the student to obtain a secondary school completion
credential for homeschool (other than a high school diploma or its recognized equivalent), a transcript or the equivalent, signed by
the student's parent or guardian, that lists the secondary school courses the student completed and includes a statement that the
student successfully completed a secondary school education in a homeschool setting.
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 pe
rson 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 Education Purpose
I certify that I
am the individual signing this Statement of Educational Purpose and that the
Printed Student’s Name
Federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending
for 2014-2015.
(Name of Postsecondary Educational Institution)
Student’s Signature
Date
Financial Aid Administrator’s Signature
Date
Notary’s Certificate of Knowledge
State of
City/County of
On
before me,
personally appeared,
(Notary’s Name) (printed name of signer)
and proved 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)
E. Certification and Signatures
Each person signing this worksheet certifies that all of the information reported on it is complete and correct. WARNING: If you purposely give
false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
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.
2
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2014 15 Dep V4 Worksheet (Golden Gate University)

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Completed 20 July 2020

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