2020-2021 V4 Verification
Worksheet Independent Student
THIS DOCUMENT CANNOT BE FAXED OR EMAILED
A. Independent Student’s Information
Student’s Last Name Student’s First Name Student’s M.I. Student’s IRSC ID Number
Student’s Street Address (include apt. no.) Student’s Date of Birth
City State Zip Code Student’s Email Address
Student’s Home Phone Number (include area code) Student’s Alternate or Cell Phone Number
B. Independent Student's Other Information to Be Verified
Check the box that applies
Someone in the student’s household received benefits from the Supplemental Nutrition Assistance Program or SNAP
(formerly known as food stamps) anytime during the 2017 or 2018 calendar year YOU MAY BE REQUIRED TO
PROVIDE DOCUMENTATION OF SNAP BENEFITS RECEIVED.
Name of person receiving benefits: Total amount received:
No one received SNAP benefits.
Complete this section if you or your spouse, if married, paid child support in 2018. List below the name of the person
who paid the child support, the name of the person to whom the child support was paid, the names of the children for
whom child support was paid, and the total annual amount of child support that was paid in 2018 for each child. YOU
MAY BE REQUIRED TO PROVIDE DOCUMENTATION OF CHILD SUPPORT PAID. If you need more space,
attach a separate page that includes the student’s name and IRSC ID at the top.
Example (Marty Jones)
Name of Person to Whom Child
Support was Paid
Example (Chris Smith)
Name of Child for Whom
Support Was Paid
Example (Terry Jones)
Support Paid in
No one paid child support.
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 and your parents reported on your FAFSA. To
verify that you provided correct information the financial aid office at your school will compare your FAFSA with the information on this
worksheet and with any other required documents. If there are differences, your FAFSA information may need to be corrected. You and at
least one parent must complete and sign this worksheet, attach any required documents, and submit the form and other required
documents to the financial aid office at your school. YOUR SCHOOL MAY ASK FOR ADDITIONAL INFORMATION. If you have
questions about verification, contact your financial aid office as soon as possible so that your financial aid will not be delayed.