Financial Aid Office
3200 West C Street
Torrington, WY 82240
p: 307.532.8224
f: 307.532.8222
financialaid@ewc.wy.edu
2018-2019
Household Support Worksheet (V6)
The 2016 income reported on your 2018-2019 FAFSA is below average for annual expense estimates. While we understand that
individuals and families can meet basic needs and additional expenses in a variety of manners, This Financial Aid Office is required to
follow-up and verify income amounts, in-kind support, as well as benefits that may not have been included on the original FAFSA as
these items can impact eligibility for certain types of aid. You must also complete the Standard Verification (V1) Worksheet.
Dependent students: complete the worksheet based off of your parent(s) household. Independent students: complete the worksheet
based off of your and your spouse’s (if applicable) household. Please note: ALL fields are required. If a section is left blank, or if
all areas are marked “N/A” without a sufficient explanation, the form will be returned to you and marked as incomplete.
________________________________________________________ ___________________ _____________________________
Last Name First Name EWC Student ID Number Phone number
*ensure your voicemail is set-up and is not full
HOUSING and UTILITIES,
(gas, power, water, internet, cable, etc.)
& FOOD/GROCERY
MISCELLANEOUS
(credit cards, cell phone,
clothing, child care, other
expenses not listed)
TRANSPORTATION
(car payment, gas, insurance,
public transit, rides from
family/friends, etc.)
2016 Expenses
Please indicate your living
situation in 2016. Select all that
apply.
Rent
Own/Mortgage
Live with relative/other
How were your 2016 housing
and utility, and food/grocery
needs met? Select all that apply.
Self
Relative/Friend
Benefits
How were 2016 miscellaneous
expenses met? Select all that
apply.
Self
Relative/Friend
Benefits
Please indicate your mode of
transportation for 2016 below.
Select all that apply.
Personal vehicle
Public transit
Rides from relative/friends
Benefits
Other
If you had a vehicle that you (or
your parent if dependent) drove
to/from school or work, please
indicate the status of ownership:
Vehicle paid for by self
Vehicle paid for by other
N/A (other mode of
transportation)
If you had a vehicle that you (or
your parent if dependent) drove
to/from school or work, please
indicate who usually paid for
gas and/or vehicle maintenance
(oil changes, etc.):
Paid for by self
Paid for by other
N/A (other mode of
transportation)
Please also indicate who paid
for auto insurance:
Paid for by self
Paid for by other
N/A (other mode of
transportation)
CHILD SUPPORT PAID. Did you pay child support for any children not listed in your household on
the Standard Verification (V1) Worksheet? Please list the TOTAL ANNUAL amount paid for each
child by Self in 2016. Attach a separate sheet or provide a statement if needed/preferred. If you did not
pay child support in 2016, please list “N/A” on the first line:
Name: ________________________________________ Age: __________ $____________________
Name: ________________________________________ Age: __________ $____________________
Name: ________________________________________ Age: __________ $____________________
INCOME BENEFITS
2016 Income & Benefits
Did you receive any income in 2016?
Select all that apply.
Student:
Income earned from work
Income earned “under the table”
Did not earn income
Parent(s) or Spouse (if applicable):
Income earned from work
Income earned “under the table”
Did not earn income
If you earned income, you MUST submit
all
student, parent (if applicable), and spouse (if
applicable)
2016 W-2 forms. If you do not have
2016 W2s, you must provide a statement that includes
your name(s), the type/name of your business, your
gross income, and why you were unable to provide
W-2s (e.g., self-employment). Sign and date.
Did you receive any of these benefits in
2016 or 2017? Select all that apply.
N/A (Not applicable)
Medicaid
Supplemental Security Income (SSI)
SNAP/Food Stamps
Free or Reduced Price School Lunch
TANF
WIC
AFDC
Low-Income Housing
LIEAP
Other: ____________________________
__________________________________
Other: ____________________________
__________________________________
Dependent students: complete the worksheet based off of your parent(s) household. Independent students: complete the worksheet based off of your
and your spouse’s (if applicable) household. Please note: ALL fields are required. If a section is left blank, or if all areas are marked as “N/A
without a sufficient explanation, the form will be returned to you and marked as incomplete.
2016
OTHER Income
and Benefits
CHILD SUPPORT RECEIVED. Did you receive child support for any children who ARE listed in your household on the Standard
Verification (V1) Worksheet? Please list the TOTAL ANNUAL amount received for each child in 2016. Attach a separate sheet or
provide a statement if needed/preferred. If you did not receive child support in 2016, please list “N/A” on the first line:
Name: ___________________________________________________________________ Age: __________ $____________________
Name: ___________________________________________________________________ Age: __________ $____________________
Name: ___________________________________________________________________ Age: __________ $____________________
HOUSING, FOOD, AND OTHER LIVING ALLOWANCES
(paid to members of the military, clergy, and others).
Please list the total cash value received in 2016. If you received
free room and board in 2016 for a job that was not awarded as
student financial aid, its value must be included in this figure. DO
NOT include rent subsidies for low-income housing, the value of
on-base military housing or the value of a basic military
allowance for housing. If not applicable, please list “N/A”:
$ ____________________
VETERANS NON-EDUCATION BENEFITS
Please list the total amount of veterans non-education benefits
received in 2016. Include Disability, Death Pension, Dependency
and Indemnity Compensation (DIC), and/or VA Educational
Work-Study allowances. DO NOT include federal veteran’s
educational benefits such as: Montgomery GI Bill, Dependents
Education Assistance Program, VEAP Benefits, Post-9/11 GI Bill.
If not applicable, please list “N/A”:
$ ____________________
OTHER UNTAXED INCOME
Please list the amount of other untaxed income not reported and not listed elsewhere on this form.
Include items such as disability, SSD/SSDI, workers’ compensation, Black Lung Benefits, untaxed
portions of health savings accounts from IRS Form 1040 Line 25, Railroad Retirement Benefits, etc.
DO NOT include student aid, Earned Income Credit, Additional Child Tax Credit, Temporary Assistance
to Needy Families (TANF), untaxed Social Security benefits, Supplemental Security Income (SSI),
Workforce Investment Act (WIA) educational benefits, combat pay, benefits from flexible spending
arrangements (e.g., cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels.
If not applicable,
please list “N/A”
$ ____________________
Statement of Support
Please provide additional details explaining how your 2016 housing, utility, food/grocery, miscellaneous, and transportation needs and
expenses were met. Include information such as if your home/vehicle (if applicable) are paid off already, if you have a garden or
livestock you live off of, and any additional information not listed on this form. Because FAFSA information may not reflect your
current situation, please also explain how your family is supporting itself now, including any changes in employment, benefits,
income, or marital status. You may attach a separate sheet. You may NOT listN/A” here it will be returned to you as incomplete.
By signing this worksheet, I/we certify that all of the information reported is complete and correct. I/we also acknowledge that I/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 spouse (if applicable) must sign:
____________________________________________________ ___________________________________________________
Student’s signature Date Parent signature (if student is dependent) Date
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.