2019-2020 Verification Worksheet
OFFICE OF FINANCIAL AID
Your Free Application for Federal Student Aid (FAFSA) was selected
for a “Verification” process which compares information from your
FAFSA with your and your parent(s) 2017 Federal income tax
information and/or other financial documents. Based on this
review, Purdue University Northwest may need to make electronic
corrections to your FAFSA information. Verification must be
completed by Sept. 30, 2020 or 120 days after your last day of
enrollment for 2019-2020, whichever is earlier. Verification
includes receipt of a valid and correct Institutional Student
Information Record (ISIR) with an official Expected Family
Contribution (EFC). Financial aid will not be disbursed until the
verification process is complete.
Federal Law requires Purdue University Northwest review the requested
information under the financial program rule 34CFR, Part 668.
What you should do
1. Complete, sign and submit this Verification Worksheet. You
and at least one parent must sign.
2. Submit your and your parent(s) 2017 IRS Tax Return
Transcript(s), if required, and any other requested
documents to the Office of Financial Aid. IRS Tax
Return Transcripts may be requested from the IRS on-
line at www.irs.gov or by calling 1-800-
3. If the student and/or parent, filed or will file, an
Amended 2017 IRS Tax Return, contact the Office of
Financial Aid at Purdue University Northwest.
Note: Deadline for submitting verification information is September 1,
2019. Eligibility for financial aid will not be determined until
verification is complete.
SECTION 1: To be completed by all students.
A. Student Information
Last Name First MI PUID
Address (include apt. no.) Date of Birth (month/day/year)
City State ZIP code Home Phone Number (include area code)
E-Mail Address Cell Phone Number (include area code)
B. Family Information
List the people
in your parent(s) household, include:
• Yourself and your parent(s) (including stepparent) even if you don’t live with your parent(s).
• Your parents’ other children, even if they don’t live with your parent(s), if (a) your parent(s) will provide more than half
of their support from July 1, 2019 through June 30, 2020 or (b) the children would be required to provide parental
information when applying for Federal Student Aid.
• 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 from July 1, 2019 through June 30, 2020.
Write the names of all household members in the space(s) below. Also write in the name of the college for any household
member, excluding your parent(s), who will be attending college at least half-time between July 1, 2019 and June 30,
2020 and will be enrolled in a degree, diploma, or certificate program. If you require additional space, please attach a
Full Name Age Relationship College
Purdue University Northwest
2200 169th Street * Hammond, IN 46323
(219) 989-2301 * FAX: (219) 989-2141
1401 S. U.S. Hwy. 421 * Westville, IN 46391
(219) 785-5460 * FAX: (219) 785-5653