3200 West C Street
Torrington, WY 82240
p: 307.532.8224
f: 307.532.8222
financialaid@ewc.wy.edu
2019-2020
Household Support Worksheet (V6)
The 2017 income reported on your 2019-2020 FAFSA is below average for annual expense estimates. While we understand that
individuals and families can meet basic needs and additional expenses in a variety of manners, This Financial Aid Office is required to
follow-up and verify income amounts, in-kind support, as well as benefits that may not have been included on the original FAFSA as
these items can impact eligibility for certain types of aid. You must also complete the Standard Verification (V1) Worksheet.
Dependent students: complete the worksheet based off of your parent(s) household. Independent students: complete the worksheet
based off of your and your spouse’s (if applicable) household. Please note: ALL fields are required. If a section is left blank, or if
all areas are marked “N/A” without a sufficient explanation, the form will be returned to you and marked as incomplete.
________________________________________________________ ___________________ _____________________________
Last Name First Name EWC Student ID Number Phone number
*ensure your voicemail is set-up and is not full
HOUSING and UTILITIES,
(gas, power, water, internet, cable, etc.)
& FOOD/GROCERY
(credit cards, cell phone,
clothing, child care, other
(car payment, gas, insurance,
public transit, rides from
2017 Expenses
Please indicate your living
situation in 2017. Select all that
apply.
Rent
Own/Mortgage
Live with relative/other
How were your 2017 housing
and utility, and food/grocery
needs met? Select all that apply.
Self
Relative/Friend
Benefits
How were 2017 miscellaneous
expenses met? Select all that
apply.
Self
Relative/Friend
Benefits
Please indicate your mode of
transportation for 2017 below.
Select all that apply.
Personal vehicle
Public transit
Rides from relative/friends
Benefits
Other
If you had a vehicle that you (or
your parent if dependent) drove
to/from school or work, please
indicate the status of ownership:
Vehicle paid for by self
Vehicle paid for by other
N/A (other mode of
transportation)
If you had a vehicle that you (or
your parent if dependent) drove
to/from school or work, please
indicate who usually paid for
gas and/or vehicle maintenance
(oil changes, etc.):
Paid for by self
Paid for by other
N/A (other mode of
transportation)
Please also indicate who paid
for auto insurance:
Paid for by self
Paid for by other
N/A (other mode of
transportation)
CHILD SUPPORT PAID. Did you pay child support for any children not listed in your household on
the Standard Verification (V1) Worksheet? Please list the TOTAL ANNUAL amount paid for each
child by Self in 2017. Attach a separate sheet or provide a statement if needed/preferred. If you did not
pay child support in 2017, please list “N/A” on the first line:
Name: ________________________________________ Age: __________ $____________________
Name: ________________________________________ Age: __________ $____________________
Name: ________________________________________ Age: __________ $____________________
INCOME BENEFITS
2017 Income & Benefits
Did you receive any income in 2017?
Select all that apply.
Student:
Income earned from work
Income earned “under the table”
Did not earn income
Parent(s) or Spouse (if applicable):
Income earned from work
Income earned “under the table”
Did not earn income
If you earned income, you MUST submit
all
student, parent (if applicable), and spouse (if
applicable)
2017 W-2 forms. If you do not have
2017 W2s, you must provide a statement that includes
your name(s), the type/name of your business, your
gross income, and why you were unable to provide
W-2s (e.g., self-employment). Sign and date.
Did you receive any of these benefits in
2017 or 2018? Select all that apply.
N/A (Not applicable)
Medicaid
Supplemental Security Income (SSI)
SNAP/Food Stamps
Free or Reduced Price School Lunch
TANF
WIC
AFDC
Low-Income Housing
LIEAP
Other: ____________________________
__________________________________
Other: ____________________________
__________________________________
