Hand deliver or mail original:
Financial Aid Office
Eastern Wyoming College
3200 West C Street
2017-2018
Independent V4 Worksheet
(Custom Verification)
Your application has been selected for review in a process called “Verification.” In this process, the information from your Free
Application for Federal Student Aid (FAFSA) will be compared with your and your spouse’s (if applicable) Federal IRS tax information
as well as other financial documents. If there are differences, your FAFSA information may need to be corrected. You must complete
and sign this worksheet. The Statement of Educational Purpose must be signed in person with a Financial Aid Office
Administrator, EWC Outreach Coordinator, or Notary Public. This worksheet and all required documents must be hand-delivered
or mailed to the Financial Aid Office at EWC.
___________________________________________________________ ____________________ __________________________
Last Name First Name M.I. EWC Student ID Number Social Security Number (last four digits)
___________________________________________________________ _______________________________________________
Mailing Address (include apartment number) E-mail Address
___________________________________________________________ _______________________________________________
City, ST, Zip Phone Number (include area code)
Fill in the information below about the household member(s) you and your spouse (if applicable) will support between July 1, 2017 and
June 30, 2018. INCLUDE YOURSELF, YOUR SPOUSE (if applicable), YOUR CHILDREN AND ANY OTHERS WHO RECEIVE
MORE THAN HALF OF THEIR SUPPORT FROM YOU. List the name of the college other household member(s) will be attending
if they are or will be enrolled in an eligible degree, diploma, or certificate program at a school eligible for Title IV funds for at
least six credits per term between July 1, 2017 and June 30, 2018.
Full name of household member
Self EWC
By signing this worksheet, I/we certify that all of the information reported on ALL THREE PAGES are complete and correct. I/we also
acknowledge that I/we have read and agree to comply with all verification policies as stated by EWC in the College Catalog and on the
EWC website. Failure to submit information in a timely fashion may result in the application being filed as inactive with no further
consideration and no federal aid for the academic year. Student and spouse (if applicable) must sign:
____________________________________________________ ___________________________________________________
Student’s signature Date Spouse’s signature Date
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
ADDITIONAL INFORMATION AND DOCUMENTS
REQUIRED TO COMPLETE VERIFICATION
ARE EXPLAINED OR PROVIDED ON THE FOLLOWING PAGES.
CERTIFICATIONS AND SIGNATURES