Fillable 2014-2015-verification-worksheet-independent-student - VerificationWorksheetIndependentStudentm

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2014-2015-verification-worksheet-independent-student - VerificationWorksheetIndependentStudentm

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2014-2015 Verification Worksheet
Independent Student
A. Student Information
1.
Write the names of all the people in the student’s household. Include:
a.
The student (yourself).
b.
Your spouse, if you are married.
c.
Your or your spouse’s children, if you or your spouse will provide more than half of their support
between July 1, 2014 and June 30, 2015, even if the children do not live with you.
d.
Other people, if they now live with you and you or your spouse provides more than half of their
support and will continue to provide more than half of their support through June 30, 2015.
2.
Include the date of birth of each person and their relationship to you.
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 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 Sec
tion 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.
D. Food Assistance
Did you 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
Full Name
Date of birth
Relationship
1.
Self
2.
3.
4.
5.
6.
INDVRW
B. Household Information
Student ID
E
Name
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
.
E. Federal Tax Information
Check the box that applies:
1.
☐ I (and spouse, if married) filed/will file a 2013 Federal IRS Tax Return, Puerto Rican, or Foreign Income Tax
Return.
2.
☐ I (and spouse, if married) was employed in 2013 and had income, but am not required to file a 2013 Federal IRS
Tax Return
List all your (and spouse, if married) employers and amount that was earned in the chart below. Submit
copies of all 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.
☐ I (and spouse, if married) was not employed in 2013, did not have income and am not required to file a 2013
Federal IRS Tax Return.
F. Asset Information
Do not leave blank. Indicate $0 or N/A if applicable.
As of the date you filed the 2014-15 FAFSA, what was your (and your spouse’s) total balance of cash, savings,
and checking accounts? Do not include student financial aid.
$
2.
As of the date you filed the 2014-15 FAFSA, what is the net worth of your (and your spouse’s) investments?
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.
3.
As of the date you filed the 2014-15 FAFSA, what is the net worth of your (and your spouse’s) current business
and/or invest farm?
$
1.
$
Signing below certifies that all of the information reported is
complete and correct. The student must sign and date.
Student’s Signature Date
WARNING: If you purposely give false or
misleading information you may be fined,
be sentenced t
o jail, or both.
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Completed 11 February 2020

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