Fillable 2017 18 Custom Verification Worksheet V4 Dependent (Eastern Wyoming College)

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2017 18 Custom Verification Worksheet V4 Dependent (Eastern Wyoming College)

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Hand deliver or mail original:
Financial Aid Office
Eastern Wyoming College
3200 West C Street
Torrington, WY 82240
2017-2018
Dependent V4 Worksheet
(Custom Verification)
Your application has been selected for review in a process called “Verification.” In this process, the information from your Free
Application for Federal Student Aid (FAFSA) will be compared with your and your parent(s)’ Federal IRS tax information. If there are
differences, your FAFSA may need to be corrected. You and at least one parent must complete and sign this worksheet. The Statement
of Educational Purpose must be signed in person with a Financial Aid Office Administrator, EWC Outreach Coordinator, or
Notary Public. This worksheet and all required documents must be hand-delivered or mailed to the Financial Aid Office at EWC.
___________________________________________________________ ____________________ __________________________
Last Name First Name M.I. EWC Student ID Number Social Security Number (last four digits)
___________________________________________________________ _______________________________________________
Mailing Address (include apartment number) E-mail Address
___________________________________________________________ _______________________________________________
City, ST, Zip Phone Number (include area code)
Fill in the information below about the household member(s) your parent(s) will support between July 1, 2017 and June 30, 2018.
INCLUDE YOURSELF, YOUR PARENT(S) (including step-parent), YOUR SIBLINGS, AND ANY OTHERS WHO RECEIVE
MORE THAN HALF OF THEIR SUPPORT FROM YOUR PARENT(S). Include siblings (not parents) who are or will be enrolled in
college at least half time (six credits) per term and who are also considered dependent for FAFSA purposes. List the name of the
college other household member(s) will be attending if they are or will be enrolled in an eligible degree, diploma, or certificate
program at a school eligible for Title IV funds for at least six credits per term between July 1, 2017 and June 30, 2018.
Full name of household member
Age
Relationship to student
College attending
Self EWC
By signing this worksheet, we certify that all of the information reported on ALL THREE PAGES are complete and correct. We also
acknowledge that we have read and agree to comply with all verification policies as stated by EWC in the College Catalog and on the
EWC website. Failure to submit information in a timely fashion may result in the application being filed as inactive with no further
consideration and no federal aid for the academic year. Student and parent must sign:
____________________________________________________ ___________________________________________________
Student’s signature Date Parent’s signature Date
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
ADDITIONAL INFORMATION AND DOCUMENTS
REQUIRED TO COMPLETE VERIFICATION
ARE EXPLAINED OR PROVIDED ON THE FOLLOWING PAGES.
STUDENT INFORMATION
FAMILY INFORMATION
CERTIFICATIONS AND SIGNATURES
Over
HIGH SCHOOL COMPLETION STATUS
Please provide ONE of the following documents that indicates what your high school completion status will be when you will begin
college in 2017-2018. Submit it with this form and any other documentation requested.
A copy of your high school diploma.
Your final official high school transcript that shows the date when the diploma was awarded.
Your official General Educational Development (GED)* certificate or transcript.
Documentation of the HiSET/TASC or other high school equivalency exam is also acceptable.
An official academic transcript that indicates you successfully completed at least a two-year program that is acceptable for full
credit toward a bachelor’s degree.
Please note: Credits transferred in from previous institutions attended may affect your maximum time frame calculation as defined
in EWC’s Satisfactory Academic Progress Policy.
If you were home schooled in Wyoming, a copy of your transcript or the equivalent, signed by a parent or guardian, along with
EWC’s Completion of Secondary Education Form for Home Schooled Students.
If you were home schooled in another state and your state requires home schooled students to obtain a secondary school
completion credential for home school (other than a high school diploma or its recognized equivalent), a copy of that credential.
If you are unable to obtain any of the forms of documentation listed above, please contact the Financial Aid Office.
COMPLETE ATTACHED FORM ALSO—READ DIRECTIONS CAREFULLY
2017-2018 IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE
The student must verify his or her identity by presenting a valid government-issued photo identification (ID), such as, but not limited
to, a driver’s license, other state-issued ID, or passport. The institution will maintain a copy of the student’s photo ID that is
annotated with the date it was received and the name of the official at the institution authorized to collect the student’s ID.
In addition, the following statement MUST be completed and signed in the presence of either a Financial Aid Administrator at
Eastern Wyoming College, an Outreach Coordinator at EWC or a Notary Public.
DO NOT COMPLETE THIS FORM IN ADVANCE.
Statement of Educational Purpose
I certify that I __________________________________________________ am the individual signing this
(print student’s name)
Statement of Educational Purpose and that the federal student financial assistance I may receive will only be
used for educational purposes and to pay the cost of attending Eastern Wyoming College for 2017-2018.
Student signature:
Date: Student ID #:
Declaración de Propósito Educativo
Certifico que yo, __________________________________________________ soy el individuo que firma esta
(Imprimir Nombre del Estudiante)
Declaración de Finalidad Educativa y que la ayuda financiera federal estudiantil que yo pueda recibir, sólo será
utilizada para fines educativos y para pagar el costo de asistir a Eastern Wyoming College para 2017-2018.
Firma del Estudiante:
La Fecha: ________________________ Número de Identificaciôn del Estudiante:___________________
IF SUBMITTING IN PERSON
Present this form with original valid government-issued photo ID, such
as, but not limited to, a driver’s license, other state issued ID, or passport.
IF SUBMITTING BY MAIL
Submit this original notarized form with photocopy of valid
government-issued photo ID to EWC.
To be completed by EWC Financial Aid Administrator
or EWC Outreach Coordinator (FAA/OC):
To be completed by Notary Public:
ID Type:
State of: City/County of:
ID Number:
Exp:
On (date):
Before me:
(notary’s name)
FAA/OC Name:
Personally appeared (printed name of signer):
FAA/OC Title/location:
On basis of satisfactory evidence of identification:
(Type of government-issued photo ID provided)
FAA/OC Signature:
Date:
To be the above-named person who signed the
foregoing instrument.
Notary signature:
WITNESS my hand and official seal:
My commission expires on: ________________________
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2017 18 Custom Verification Worksheet V4 Dependent (Eastern Wyoming College)

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Completed 23 July 2020

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