2021-2022 Dependent Number in College Verification Form
The U.S. Department of Education selected your student’s 2021-2022 FAFSA for verification. Please complete,
print, sign, and submit to the Financial Aid Office. Instructions for submission are at the bottom of the form.
A. Student Information
First Name MI
Last Name
VWCC Student ID - REQUIRED
B. Number in College
List the people in your Uparent(s)’ household that will be attending college at an eligible postsecondary institution Uany
time between July 1, 2021 and June 30, 2022, and will be enrolled in a degree, diploma, or certificate program.
Household members to include are:
Yourself;
Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2021
through June 30, 2022, or if the other children would be required to provide parental information when completing
a 2021-2022 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, 2022.
In the spaces below, you should only provide information for household members that will be attending college at an
eligible postsecondary institution during the time period describe above.
UNOTE: We may require additional documentation
if we have reason to believe that the informatioUn Uprovided below is inaccurate.U
First Name
Last Name
Age
Relationship to You
College Name
6 credits
(halftime)? Yes or
EXAMPLE: Missy
Jones
18
Sister
XYZ University
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 Required
Date
______________________________________________________________________
_______________
Parent Signature Required
Date
WAYS TO SUBMIT THIS FORM
(1) 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 (2) Fax forms to 540-857-6208Phone: (855)874-6690
(
Revised 10_2020)