Fillable DEPENDENT VERIFICATION WORKSHEET - V5 2021-2022 (Southeast Technical Institute)

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DEPENDENT VERIFICATION WORKSHEET - V5 2021-2022 (Southeast Technical Institute)

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DEPENDENT VERIFICATION WORKSHEET - V5
2021-2022
FEDERAL STUDENT AID PROGRAMS
A. Student Information
SEND ALL PAPERWORK TO:
Southeast T
echnical College
Oce of Financial Aid
2320 N Career Ave
Sioux Falls, SD 57107
Fax: 605-367-8305
Phone: 605-
367-7867
Email: financialaid@southeasttech.edu
Last Name First Name M.I. Student ID# or Social Security Number
Address (include Apt No.) Phone Number
City State Zip Email
B. Please identify the people in your parents’ household, include your self and your parent(s):
Number in Household on FAFSA: Please list those people in this section.
• If your parent is remarried, include your step-parent
• If your parents support other people and will continue to provide more than half of their support
between July 1, 2021 and June 30, 2022 (such as their other children), include them in the household.
• If your parents’ other children would be required to provide parental information when completing the FAFSA,
include them in the household.
Name (First & Last) Age Relationship
Student/Self
B. Please identify the people listed in the above household who will be attending college at least
half-time between July 1, 2021 and June 30, 2022 and will be in a degree or certificate program.
Number in College on FAFSA: Please list those people in this section.
Name
Student/Self
Name of College/Post Secondary School
Southeast Technical College
D. Refer to the enclosed sheet for detailed instructions regarding tax information requested, then
complete and sign the back of this form.
E. Student: Did you file a 2019 U.S. Federal Tax Return?
IF YES:
Choose One
I successfully used the
Link to IRS tax
information.
Attached is a copy of
my 2019 Federal tax
return (signed) OR 2019
IRS Tax Return Transcript.
I have ordered my 2019
IRS Tax Return Transcript
and will submit it when it
is received
IF NO:
Choose One
I did not earn income during 2019 and I was not required to file a 2019
Federal Tax Return
I was not required to file a 2019 Federal Tax Return but did earn income
during 2019. Attached are my 2019 W-2s OR my 2019 IRS Wage and
Income Transcript.
NON-FILERS ONLY
List the Names of ALL
the Parent(s)’ Employers
Enter the Amount
Earned from each
Employer in 2019
W-2 Attached?
(circle one)
Yes No
Yes No
Yes No
F. Parent(s): Did you file a 2019 U.S. Federal Tax Return?
IF YES:
Choose One
I successfully used the
Link to IRS tax
information.
Attached is a copy of
my 2019 Federal tax
return (signed) OR 2019
IRS Tax Return Transcript.
I have ordered my 2019
IRS Tax Return Transcript
and will submit it when it
is received
IF NO:
Choose One
I did not earn income during 2019 and I was not required to file a 2019
Federal Tax Return
I was not required to file a 2019 Federal Tax Return but did earn income
during 2019. Attached are my 2019 W-2s OR my 2019 IRS Wage and
Income Transcript.
NON-FILERS ONLY
List the Names of ALL
the Parent(s)’ Employers
Enter the Amount
Earned from each
Employer in 2019
W-2 Attached?
(circle one)
Yes No
Yes No
Yes No
G. High School Completion Status
Provide one of the following documents that indicate the student’s high school completion status when
beginning college in 2021-2022.
A copy of the student’s high school diploma
A copy of the student’s final ocial high school transcript that shows the date when the diploma was awarded
A copy of the student’s General Educational Development (GED) certificate or GED transcript
H. Documentation of Identity/Statement of Educational Purpose
This section must be completed either in the presence of Financial Aid Sta or Public Notary.
In order to complete the verification process, you will need to appear in person at Southeast Technical
College and present your government issued ID (such as a driver’s license, military ID, passport) and this
verification worksheet to an institutionally authorized Financial Aid sta member. The Financial Aid sta
member must validate the statement below at the time of submission by maintaining a copy of your photo
ID and by providing a signature and date.
Statement of Educational Purpose
I certify that I, am the individual signing this Statement of
(Print Student’s Name)
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 Southeast Technical College for 2021-2022.
Student’s Signature Date Financial Aid Sta’s Signature Date
If you cannot appear in person to submit this verification worksheet, you will need to provide a copy of your
government issued photo ID and this verification worksheet notarized by a public notary.
Notary’s Certificate of Knowledge
State of City/County of on before
me, personally appeared, and provided to me on basis of
satisfactory evidence of identification
(Printed Notary’s Name) (Printed Student’s Name)
to be the above named person who signed the
(Type of Government Issued
foregoing instrument.
Photo ID Provided)
WITNESS my hand and ocial seal
(Notary’s Signature) (Date Commission Expires)
(Seal)
I. Certification of signatures: SENDING WITHOUT SIGNATURES WILL DELAY THE FINANCIAL AID PROCESS.
By signing this worksheet, we certify that all information reported on this form to qualify for Federal aid is
complete and correct.
Student Date Parent Date
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined,
sentenced to jail, or both.
SOUTHEASTTECH.EDU
Updated: December 10, 2020
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DEPENDENT VERIFICATION WORKSHEET - V5 2021-2022 (Southeast Technical Institute)

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Completed 4 February 2021

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