Fillable 2018-2019 Low/No Income Verification Worksheet - Dependent Students (Wayne Community College)

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2018-2019 Low/No Income Verification Worksheet - Dependent Students (Wayne Community College)

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2018-2019
Low/No Income Verification Worksheet - Dependent Students
The income reported on your 2018-2019 FAFSA appears to be too low to meet basic living expenses. While this may be due to the
exclusion of certain types of income from the FAFSA, federal law states that we have the right to confirm the information that was
reported before awarding and/or disbursing federal student aid. The Financial Aid Office will compare the information reported on the
FAFSA for you and your parent(s) with the information reported on this worksheet and any other required documentation. This
worksheet may be requested in addition to other verification forms required by the U.S. Department of Education. *Your eligibility for
financial aid cannot be determined until the verification process has been completed.
STUDENT NAME:
____________________________________________________________ WCC ID #: ______________________________
E-MAIL ADDRESS: ___________________________________________________________ PHONE #: _______________________________
INSTRUCTIONS: You, and a parent whose information was reported on the FAFSA, must complete this worksheet, attach any
required documentation, sign, and submit the completed package to the WCC Financial Aid Office. If your parent was married
(or remarried) on the day you signed and submitted your FAFSA, you are required to provide information for each parent and/or step-
parent. If there are any discrepancies between the information reported on your FAFSA and the documents submitted to our office,
your signature on this form authorizes our office to make the appropriate corrections to your FAFSA.
**For FAFSA purposes, your parents’ household includes you AND your parent(s)/step-parent, even if you do not live with your
parent(s); your parents’ other children, even if they do not live with your parent(s), IF your parent(s) will provide more than half of their
support between July 1, 2018 and June 30, 2019, OR if the children would be considered dependent when completing a 2018-2019
FAFSA. Include other people ONLY if they now live with your parent(s) AND your parent(s) provide more than half of their support
AND will continue to provide more than half of their support between July 1, 2018 and June 30, 2019. IMPORTANT: These guidelines
apply to DEPENDENT students only. (Independent students should complete the Low/No Income Verification Worksheet-Independent Students)
NOTE: Support includes money, gifts, loans, housing, food, clothing, transportation, medical/dental care, college tuition, etc.
A. TAXABLE INCOME (enter a response for EACH question below; incomplete forms will be returned)
TOTAL RCVD
IN 2016
IF YES, SUBMIT REQUIRED
DOCUMENTATION
YES
NO
$ ______________
All 2016 W-2’s, 1099’s, and/or other
statements of income earned
YES NO $ ______________ 2016 Form 1099-G
YES
NO
$ ______________
2016 Form 1099-R
YES
NO
$ ______________
2016 Form 1099-MISC, 1099-G, etc.
YES
NO
$ ______________
2016 SSA-1099, Form 1099-R or W-2
YES
NO
$ ______________
Copy of the Court Order
YES
NO
$ ______________
2016 Form W-2G
Did any member of your parents’ household receive
income from the sources listed below during 2016?
Money earned from working (inc
luding cash
earnings that were not reported on a W2 or 1099)
+
Unemployment Compensation
Pension or Retirement Funds
Business, Rental or Farm Income
Disability Payments
Alimony or Spousal Support
Gambling or Lottery Winnings
Interest or Dividends
YES
NO
$ ______________
2016 Form 1099-INT or 1099-DIV
ENTER THE TOTAL OF ALL SOURCES OF TAXABLE INCOME HERE
$ ______________
+
Per IRS guidelines, individuals earning net self-employment income of $400 or more are required to file a tax return.
B. UNTAXED INCOME (enter a response for EACH question below; incomplete forms will be returned)
Did any member of your parents’ household receive
income from the sources listed below during 2016?
TOTAL RCVD
IF YES, SUBMIT REQUIRED
DOCUMENTATION
Supplemental Security Income (SSI)
YES
NO
2016 Benefit Verification Letter
Child Support for any of your parent’s children YES NO $ _____________
Proof of Child Support received
January – December 2016
Worker’s Compensation
YES
NO
Final Check Stub from 2016
Veteran’s Non-Educational Benefits
YES
NO
VA Award Letter
ENTER THE TOTAL OF ALL SOURCES OF UNTAXED INCOME HERE
RETURN THIS COMPLETED FORM WITH REQUIRED DOCUMENTATION TO:
Wayne Community College - Financial Aid Office - PO Box 8002 - Goldsboro, NC 27533-8002
FAX: 919-736-9425
Wayne Community College is accredited by the Southern Association of Colleges and Schools Commission on Colleges to award associate degrees. Contact the
Commission on Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097 or call 404-679-4500 for questions about the accreditation of Wayne Community College.
The Commission on Colleges may be contacted only if there is evidence that Wayne Community College is significantly non-compliant with a requirement or standard.
Accreditation standards are located at: http://www.sacscoc.org/principles.asp.
Inquiries about Wayne Community College, such as admission requirements, financial aid, educational programs, etc. should be addressed directly to Wayne Community
College and not the Commission’s office.
C. INCARCERATION (check the appropriate box; incomplete forms will be returned)
Was your parent(s) confined to jail/prison at any time
during 2016?
YES NO
If YES, submit proof of incarceration period
(documentation may vary depending on location)
D. PUBLIC ASSISTANCE (enter a response for EACH question below; incomplete forms will be returned)
Did any member of your parents’ household receive benefits
from the sources listed below during 2016 OR 2017?
MONTHLY
VALUE
HOW MANY MONTHS
RCVD IN 2016?
Housing Assistance (Section 8, HUD, etc.)
YES
NO
$________________
_____________
Work First/TANF YES NO
$________________ _____________
Food & Nutrition Services (Food Stamps, SNAP, etc.) YES NO
$________________ _____________
Medicaid or WIC (circle one OR both) YES NO
$________________ _____________
ENTER THE TOTAL MONTHLY VALUE OF ALL BENEFITS HERE
$________________
E. ADDITIONAL INFORMATION (enter a response for EACH question below; incomplete forms will be returned)
Did any member of your parents’ household receive income OR support from the sources listed below in 2016 OR 2017?
Refunds from Federal and/or State Financial Aid YES NO If YES, what school did the household member
attend? ___________________________
Cash support provided by a relative or friend
(to cover transportation, miscellaneous personal items,
etc.)
YES
NO
If YES, who provided the cash support?
Name: ________________________________
Relationship to your parent:________________
TOTAL amount received in 2016: $__________
Payment of bills listed in your parent’s name by a
relative, friend or relief agency
(Salvation Army, church,
etc.)
YES
NO
If YES, who paid the bills?
Name: ________________________________
Relationship to your parent: _______________
TOTAL amount paid in 2016: $___________
Housing provided at no cost to your parent(s) by a
relative, friend or relief agency
(Salvation Army, church,
etc.)
YES
NO
If YES, who provided the housing?
Name: ________________________________
Relationship to your parent: _______________
# of months housing was provided:
__________
Food and/or groceries provided at no cost to your
parent(s) by a relative, friend or relief agency
(Salvation Army, church, etc.)
YES
NO
If YES, who provided the food/groceries?
Name: ________________________________
Relationship to your parent: _______________
# of months received: ______________
USE THE SPACE BELOW TO PROVIDE ANY OTHER INFORMATION NEEDED TO EXPLAIN HOW BASIC LIVING EXPENSES
(food, shelter, utilities, clothing, personal items, etc.) WERE MET IN 2016.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
~If more space is needed, attach a separate page that includes the student’s name and WCC ID#.
F. CERTIFICATION AND SIGNATURES
By signing below, I certify that all information reported on this form and any documentation provided is true and complete.
________________________________________________________ _______________________
STUDENT SIGNATURE (REQUIRED) DATE
________________________________________________________ _______________________
PARENT SIGNATURE (REQUIRED)
DATE
WARNING: If you purposely provide false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
VOUCHER ONLY
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2018-2019 LowNo Income Verification Worksheet - Dependent Students (Wayne Community College)

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Completed 26 July 2020

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