Fillable 2014-2015-verification-worksheet-dependent-student - VerificationWorksheetDependentStudentm

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2014-2015-verification-worksheet-dependent-student - VerificationWorksheetDependentStudentm

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2014 - 2015 Verification Worksheet
Dependent Student
A. Student Information
Student ID
E
Name
B. Household Information
1. Write the names of all the people in your parent(s)’ household. Include:
a.
Yourself (the student).
b.
Your parent(s). If your parents are divorced, indicate the parent you lived with the most during the last 12
months.
If you did not live with one parent more than the other, list the parent who supplied more than half of your
support. Include your step-parent if your parent is remarried. If your legal parents (biological or adopted)
are unmarried but live together, list both parents. Grandparents, foster parents, legal guardians, aunt
and uncles are not considered parents unless they have adopted you.
c.
Your parent(s)’ other children, if your parents will provide more than half of their support between July 1, 2014
and June 30, 2015, or if the children would be required to provide parental information when applying for
federal aid.
d. Other dependents, if they now live with your parent(s), your parent(s) provide more than half of their support
and will continue to provide more than half of their support between July 1, 2014 and June 30, 2015.
2.
Include the date of birth of each person and their relationship to you (the student).
3.
Add the name of the college for any household member who will be enrolled in a degree, diploma, or certificate
program at least half-time between July 1, 2014 and June 30, 2015.
If more space is needed, provide a separate page with your name and EMU ID number at the top.
C. Child Support Paid
Did you (the student) or your parent(s) pay
child support due to divorce, separation, or as a result of a legal requirement
for any children not included in Section B of this form?
Yes. Complete table below. No. Proceed to Section D.
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 2013
$
$
$
Note: If we have reason to believe that the information regarding child support paid is not accurate, we may require
additional documentation.
Full Name Date of birth Relationship to you Name of College
1.
Self Eastern Michigan University
2.
3.
4.
5.
6.
DEPVRW
1
D. Food Assistance
Did you (the student) or any person in your household (listed in Section B of this form) receive benefits from the Supplemental
Nutrition Assistance Program (SNAP) e.g., Michigan Food Assistance Program, Bridge Card in 2012 or 2013?
Yes No
Check the box that applies:
1.
☐ Parent(s) filed/will file a 2013 Federal IRS Tax Return, Puerto Rican, or Foreign Income Tax Return.
2.
☐
Parent(s)
was
employ
ed and had income, but
will not file and ar
e not
required
to
fi
le
a
2013
Federal IRS Tax Return
List all parent(s)’ employers and amount that was earned in 2013 in the chart below. Submit copies of all parent(s)
2013 W-2 forms.
Name of Employer Amount Earned in 2013
2013 W-2 Form received from
employer?
$ Yes No
$
Yes No
$
Yes No
3.
☐ Parent(s) not employed, did not have income and are/were not required to file a 2013 Federal IRS Tax Return.
F. Student Federal Tax Information
Check the box that applies:
1.
☐ Student filed/will file a 2013 Federal IRS Tax Return,
Puerto Rican, or Foreign Income Tax Return.
2.
☐ Student was employed in 2013 and had income but will not file and are
not required to file a 2013 Federal IRS Tax
Return. List all student’s employers and amount that was earned in 2013 in the chart below. Submit copies of all
student 2013 W-2 forms.
Name of Employer Amount Earned in 2013
2013 W-2 Form received
from employer?
$ Yes No
$ Yes No
$ Yes No
3.
☐ Student was not employed in 2013, did not have income and was not required to file a 2013 Federal IRS Tax Return.
E. Parent Federal Tax Information
2
Office of Financial Aid
.
Phone: 734.487.0455
.
Fax: 734.487.4281
.
Email: financial_aid@emich.edu
.
Web: www.emich.edu/finaid
G. Asset Information
Student Asset
Information
Parent Asset
Information
$ ________________
$ ________________
$ ________________
$ ________________
$ ________________
$ ________________
Each person signing below certifies that all of the information
reported is complete and correct. The student and one parent
whose information was reported on the FAFSA must sign and date.
Student’s Signature Date
Parent’s Signature Date
WARNING: If you purposely give false or
misleading information you may be fined,
be sentenced to jail, or both.
As of the date you filed the 2014-2015 FAFSA, what is your total current
balance of cash, savings and checking accounts?
Do not include student financial aid.
As of the date you filed the 2014-2015 FAFSA, what is the net worth of
your investments, including real estate? Net worth means current value
minus debt.
Investments include: real estate (do not include the home in which you
live), rental property, trust funds, UGMA and UTMA accounts, money
market funds, mutual funds, certificates of deposit, stocks, stock options,
bonds, other securities, Coverdell savings accounts, 529 college savings
plans. Do not include: the value of life insurance, retirement plans (pension
funds, annuities, noneducational IRAs, Keogh plans, etc.)
As of the date you filed the 2014-2015 FAFSA, what is the net worth
of your current businesses and/or investment farms?
Business or farm value includes the current market value of land, buildings,
machinery, equipment, inventory, etc.
Do not include the net worth of a family owned and controlled small business
with not more than 100 full-time or full-time equivalent employees.
Do not leave blank. Indicate zero or Not Applicable (N/A) if appropriate.
3
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Completed 11 February 2020

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