STUDENT FINANCIAL SERVICES
2020-2021 DEPENDENT CUSTOM
VERIFICATION WORKSHEET
D4
Your 2020-2021 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 an y required
documents, and submit the form and other required documents to us. We may ask for additional information. If you have questio ns 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 16, 2021 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, 2020, through
June 30, 2021, or if the other children would be required to provide parental information if they were completing a FAFSA
for 2020-2021. 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, 2021.
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, 2020, and June 30, 2021, 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 2020-2021
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 the 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.
