2020-2021 Dependent Household Size Verification Form
The U.S. Department of Education selected your student’s 2020-2021 FAFSA for verification. Please complete, print, sign, and
submit this form to the Financial Aid Office. Instructions for submission are at the bottom of the form.
A. Student Information
B. Household Information
List the people in your parent(s)’ household. People included in your parent(s) household are as follows:
Yourself;
Your parent(s), including a stepparent, even if you do not live with your parent(s);
Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2020 through June 30, 2021, or if
the other children would be required to provide parental information when completing a 2020-2021 federal financial aid application
(FAFSA). Include children who meet either of these descriptions, even if they do not live with your parent(s).
Other people 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 through June 30, 2021.
If more space is needed attach an additional sheet with the student’s name and ID at the top. The student and parent must sign and date
the additional sheet.
First Name
Last Name
Age
Relationship to You
EXAMPLE: Missy
Jones
18
Sister
Self
C. Certification and Signatures
Each person signing below certifies that all the information reported on this worksheet is complete, correct, and any additional information
is attached. The student and one parent MUST sign and date this section.
WARNING: If you purposely give false or misleading information on this worksheet you may be fined, sentenced to jail, or both.
______________________________________________________________________ _______________
Student Signature Date
______________________________________________________________________ _______________
Parent Signature Date
HOW TO SUBMIT THIS FORM
Upload this form directly into the Student Information System (SIS) by logging into MY VWCC. Once logged in, go to the Student
Center and select the ‘VWCC 20/21 Dependent HH Size’ from the ‘To Do List’ list to attach and upload the form. You can also upload
the form at www.virginiawestern.com
by clicking ‘Contact Us, and then clicking the 24/7 Student Support icon. Once you log in
you can submit documents. Fax forms to 540-857-6208
Phone: (855)874-6690
First Name
MI
Last Name
VWCC Student ID - REQUIRED