2021-2022 Dependent Household Size Verification Form
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 540-857-6208♦Phone: (855)874-
6690
(Revised 10_2020)
The U.S. Department of Education selected your student’s 2021-2022 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
VWCC Student ID - REQUIRED
B. Household Information
List the people in your Uparent(s)’ householdU. 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, 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.
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.
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.
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Student Signature Required
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Parent Signature Required
