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20202021 Verification of Number
of Household Members and Number in College
Your 2020-2021 Free Application for Federal Student Aid (FAFSA) has been selected for review in a process called verification. In this process we will
compare the information from your FAFSA application with the information provided on this form and with any other required documents. By law, we
have the right to ask you for this information before awarding federal aid. If there are differences, corrections will be submitted to the federal processor.
Complete this process as soon as possible in order for your file to be ready to review for eligible awards.
A. Student’s Information
Student’s Last Name Student’s First Name Student’s M.I. Mitchell Student ID
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. Household Information
Check here if you are a dependent student, include:
Check here if you are an independent student,
Yourself
include:
Your parent(s) used on FAFSA, (include step-parent)
Yourself
Your parent(s)’ other dependent children if your parent(s) will provide more
Your spouse (if you are married)
than half of their support from July 1, 2020 through June 30, 2021, or the
Your children, if you will provide more than half of their
children would be required to provide parental information if filing a FAFSA
support from July 1, 2020 through June 30, 2021
Other people, only if they now live in your parents’ household, and your
Other people, only if they live in your household and you
parents will provide more than half of their support from July 1, 2020 through
provide more than half of their support and will continue
June 30, 2021
to do so from July 1, 2020 through June 30, 2021
Don’t list your parents’ college if they are also in college
Full Name
Age
Relationship
College
Will be Enrolled at Least
Half Time
Self
Mitchell Comm. College
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Note: We may require additional documentation if we have reason to believe that the information regarding the household members enrolled
in eligible postsecondary educational institution is inaccurate.
WARNING: If you purposely give false or misleading
information on this worksheet, you may be fined, be
Certification and Signature
sentenced to jail, or both.
I certify that all of the information reported on this worksheet is complete and
correct. The student must sign this worksheet. A parent’s signature is required for dependent students.
Student’s Signature Date
Parent’s Signature (if dependent) Date
Mitchell Community College Financial Aid Office, 500 West Broad Street, Statesville, NC 28677-5264 PH (704) 978-5435 F (704) 978-1302
MCC-459 Equal Opportunity College Rev. 05/20
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