Fillable Custom Verification Worksheet V4 Dependent (Eastern Wyoming College)

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Custom Verification Worksheet V4 Dependent (Eastern Wyoming College)

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The Custom Verification Worksheet V4 Dependent (Eastern Wyoming College) form is 3 pages long and contains:

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  • 6 check-boxes
  • 76 other fields

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File type: PDF

U.S.A. forms for Eastern Wyoming College

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SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)/FOOD STAMPS
Hand deliver or mail original:
Financial Aid Office
Eastern Wyoming College
3200 West C Street
Torrington, WY 82240
STUDENT INFORMATION
CHILD SUPPORT PAID
FAMILY INFORMATION
2014-2015
Dependent 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 family’s (if applicable) actual information. If there
are differences, your FAFSA information may need to be corrected. You and at least one parent
must complete all sections of this
worksheet, attach all required documents and you must sign and submit it in person to the Financial Aid Office/Outreach
Coordinator or Notary Public.
__________________________________________________________ ____ __________________________________________
Last Name First Name M.I. EWC Student ID Number
______________________________________________________________ __________________________________________
Address (include apartment number) Social Security Number (last four digits)
______________________________________________________________ __________________________________________
City, ST, Zip Phone Number (include area code)
Fill in the information below about the people your parent(s) will support between July 1, 2014 and June 30, 2015. INCLUDE
YOURSELF, YOUR PARENT(S) (including step-parent), YOUR SIBLINGS AND ANY OTHERS WHO RECEIVE MORE THAN
HALF OF THEIR SUPPORT FROM YOUR PARENT(S). Include siblings who are enrolled in college at least half time (six credits)
and who are also considered dependent for FAFSA purposes. List the name of the college others will be attending if they are enrolled
in a degree, diploma, or certificate program for at least six credits per term between July 1, 2014 and June 30, 2015.
Full name of household member
Age
Relationship to student
Self EWC
Did anyone in your household (listed above) receive benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly
food stamps) in 2012 OR
2013?
No Yes If asked by my school, I will provide documentation of the receipt of SNAP benefits during 2012 and/or 2013.
Did anyone in your household PAY child support in 2013 for any children NOT listed above as a household member?
No Yes If “yes”, complete box below. If asked by my school, I will provide documentation of child support payment.
Name of person who
PAID child support
Name of person to whom
child support was paid
Name of child for whom
child support was paid
Total annual
amount of child
support paid in 2013
CERTIFICATIONS AND SIGNATURES
HIGH SCHOOL COMPLETION STATUS
DEPENDENT
Please provide ONE of the following documents that indicates your high school completion status when you will begin college in
2014-2015 and submit it with this form and any other documentation requested.
A copy of your high school diploma.
Your final official high school transcript that shows the date when the diploma was awarded.
Your official General Educational Development (GED)* certificate or transcript.
Documentation of the HiSET or other high school equivalency exam is also acceptable.
An official academic transcript that indicates you successfully completed at least a two-year
program that is acceptable for full credit toward a bachelor’s degree.
Please note: Credits transferred in from previous institutions attended may affect your maximum
time frame calculation as defined in EWC’s Satisfactory Academic Progress Policy.
If you were home schooled in Wyoming, a copy of your transcript or the equivalent, signed by a parent
or guardian, along with EWC’s Completion of Secondary Education Form for Home Schooled Students.
If you were home schooled in another state and your state requires home schooled students to obtain a
secondary school completion credential for home school (other than a high school diploma or its
recognized equivalent), a copy of that credential.
If you are unable to obtain any of the forms of documentation listed above, please contact the Financial Aid Office.
By signing this worksheet, we certify that all of the information reported is complete and correct. We also acknowledge that we have
read and agree to comply with all verification policies as stated by EWC. 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
one parent must sign:
___________________________________________________ _____________________________________________________
Student’s signature Date Parent’s signature Date
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
COMPLETE ATTACHED FORM ALSO—READ DIRECTIONS CAREFULLY
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2014-2015 IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE
The student must verify his or her identity by presenting a valid government-issued photo identification (ID), such as, but
not limited to, a driver’s license, other state-issued ID, or passport.
The institution will maintain a copy of the student’s
photo ID that is annotated with the date it was received and the name of the official at the institution authorized to
collect the student’s ID.
In addition, the following statement MUST be completed and signed in the presence of either a Financial Aid Administrator
at Eastern Wyoming College, an Outreach Coordinator at EWC or a Notary Public.
DO NOT COMPLETE THIS FORM IN ADVANCE.
Statement of Educational Purpose
I certify that I __________________________________________________ am the individual signing this
(print student’s name)
Statement of Educational Purpose and that the federal student financial assistance I may receive will only be
used for educational purposes and to pay the cost of attending Eastern Wyoming College for 2014-2015.
Student signature:
Date: Student ID #:
Declaración de Propósito Educativo
Certifico que yo, __________________________________________________ soy el individuo que firma esta
(Imprimir Nombre del Estudiante)
Declaración de Finalidad Educativa y que la ayuda financiera federal estudiantil que yo pueda recibir, sólo será
utilizada para fines educativos y para pagar el costo de asistir a Eastern Wyoming College para 2014-2015.
Firma del Estudiante:
La Fecha: ________________________ Número de Identificaciôn del Estudiante:___________________
IF SUBMITTING IN PERSON
Present this form with original valid government-issued photo ID,
s
uch as, but not limited to, a driver’s license, other state issued ID, or
passport.
IF SUBMITTING BY MAIL
Submit this original notarized form with photocopy of valid
government-issued photo ID to EWC.
To be completed by EWC Financial Aid Administrator
or EWC Outreach Coordinator (FAA/OC):
To be completed by Notary Public:
ID Type:
State of: City/County of:
ID Number:
Exp:
On (date):
Before me:
(notary’s name)
FAA/OC Name:
Personally appeared (printed name of signer):
FAA/OC Title/location:
On basis of satisfactory evidence of identification:
(Type of government-issued photo ID provided)
FAA/OC Signature:
Date:
To be the above-named person who signed the
foregoing instrument.
Notary signature:
WITNESS my hand and official seal:
My commission expires on: ________________________
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Custom Verification Worksheet V4 Dependent (Eastern Wyoming College)

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Completed 25 July 2020

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