student financial services
20192020 DEPENDENT CUSTOM
VERIFICATION WORKSHEET
Your 2019-2020 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law
says that before awarding Federal Student Aid, we may ask you to confirm the information you reported on your FAFSA. To verify
that you provided correct information, we will compare your FAFSA with the information on this institutional verification document
and with any other required documents. If there are differences, your FAFSA information may need to be corrected. You and a
parent whose information was reported on the FAFSA must complete and sign this institutional verification document, attach any
required documents, and submit the form and other required documents to us. We may ask for additional information. If you have
questions about verification, contact us as soon as possible so that your financial aid will not be delayed.
Deadline: To determine your eligibility for federal and/or state funds, your verification documents must be received by our office
no later than August 14, 2020 or 120 days after your last date of enrollment, whichever comes first. Failure to do so by the stated
deadline will result in a loss of eligibility for the current academic year.
MTC must review the requested information, under the financial aid program rules (34 CFR, Part 668).
A. STUDENT INFORMATION
Print the information requested below:
Last Name First Name M.I. MTC ID
Address (include apt.no.) MyMTC Email Address
City State Zip Code Student Date of Birth
Student Home Phone Number (include area code) Student Alternate or Cell Phone (include area code)
B. FAMILY INFORMATION
List below the people in the parent’s household, include:
> The student
> The parents (including a stepparent) even if the student doesn’t live with the parents.
> The parent’s other children if the parents will provide more than half of the children’s support from July 1, 2019, through
June 30, 2020, or if the other children would be required to provide parental information if they were completing a FAFSA
for 2019-2020. Include children who meet either of these standards, even if a child does not live with the parents.
> Other people if they now live with the parents and the parents provide more than half of the other person’s support, and
will continue to provide more than half of that person’s support through June 30, 2020.
Number in college:
Include in the space below information about any household member, excluding the parents,
who is, or will be, enrolled at least half time in a degree, diploma, or certificate program at an eligible postsecondary
educational institution any time between July 1, 2019, and June 30, 2020, and include the name of the college.
If more space is needed, provide a separate page with the student’s name and ID number at the top.
Full Name Age Relationship* College Attending in 2019-2020 Will be enrolled at
least half time?
1. Self Midlands Technical College Yes/No
2.
3.
4.
5.
6.
Note: We may require additional documentation, if we have reason to believe that the information regarding the
household members enrolled in eligible postsecondary educational institutions is inaccurate.
**If relationship listed is not a parent, sibling, or child, you must also complete Section D of the Clarification statement
explaining the reason this individual should be included in your household size.
D4
