2020-21 Verification of Dependent You Support (other than your children or spouse) Independent
Your FAFSA application was selected by the U.S. Dept. of Education for review in a process called “verification.” In this process we are
required by federal law (34 CFR, Part 668) to compare the information from your FAFSA application with the information provided on
this form. If there are differences between your application information and your verification documents, we may need to correct your
FAFSA information. We cannot process your financial aid until verification has been completed. Please provide the required documents
as soon as possible.
A. Student Information (please print clearly)
Last Name First Name M.I. Student ID Number or Star ID
Email Address Phone Number (include area code)
Address City State Zip Code
B. Family Information
You reported on your FAFSA that you have a dependent you support (other than your children or spouse) *
Name of dependent: _____________________________________________ Dependent’s age: ________
Relationship to you: _________________________
Does this dependent live in your home? _____ Yes _____ No
What income or other resources do you have available to support you and your dependent (i.e., earnings, MFIP, food support).
You must also provide court documents showing proof of your legal guardianship for the above named dependent.
WARNING: If you purposely give false or misleading information, you may be fined, sentenced to prison, or both.
I certify that all of the information reported on this worksheet is complete and correct.
Student Signature Date
*If you answered YES to this question in error on your FAFSA, you are not independent for financial aid purposes. You will need to go online to
www.fafsa.gov to correct your FAFSA and add parental information including a parent signature (FSA ID).
3300 Century Avenue North
White Bear Lake, MN 55110
A MEMBER OF THE MINNESOTA STATE COLLEGES & UNIVERSITY SYSTEM
AN AFFIRMATIVE ACTION EQUAL OPPORTUNITY EMPLOYER & EDUCATOR
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