SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)/FOOD STAMPS
CERTIFICATIONS AND SIGNATURES
DEPENDENT
Did anyone in your parent’s household (listed above) receive benefits from the Supplemental Nutrition Assistance Program or SNAP
(formerly food stamps) in 2012 OR
2013?
No Yes Who received SNAP benefits (list all): __________________________________________________________________
If asked by my school, I will provide documentation of the receipt of SNAP benefits during 2012 and/or 2013.
The easiest way to verify income is to use the IRS Data Retrieval Tool when completing or updating your FAFSA on the federal web
site. If you did not use the IRS Data Retrieval Tool when completing or updating the FAFSA, you must provide an IRS Tax Return
Transcript. Due to changes in federal regulations, schools can no longer accept photocopies of tax returns. To request an IRS
Tax Return Transcript please visit www.irs.gov/Individuals/Get-Transcript
to download and print your transcript
immediately, or request the transcript be mailed to your address on record. Be sure to request a Tax Return Transcript, NOT an
Account Transcript. If you or your parent(s) did not and will not file a 2013 Federal tax return, please check the appropriate box
below. Please provide W-2 forms if you worked, but were not required to file a tax return.
I used the IRS Data Retrieval process to transfer my 2013 IRS income tax return information when completing/updating my
2014-2015 FAFSA.
My signed 2013 Federal IRS Tax Return Transcript(s) is attached. (Foreign tax return filers may submit signed photocopies.)
See Income Verification section above for important details.
I was not employed and had no income earned from work in 2013.
I worked in 2013 but was not required to file a tax return. My 2013 W-2s are enclosed. My earnings were: $______________
If you received income earned from the Federal Work-Study Program, need-based employment portions of fellowships and
assistantships, or a cooperative education program offered by a college in 2013, write in the type and amount you actually
included on your 2013 Federal tax return: Type: __________________________________________ $______________
My parent(s) used the IRS Data Retrieval process transfer their 2013 IRS income tax return information when
completing/updating my 2014-2015 FAFSA.
My parent(s)’ signed 2013 Federal IRS Tax Return Transcript(s) is/are attached. (Foreign tax filers may submit signed
photocopies.) See Income Verification section above for important details.
My parent(s) were not employed and had no income earned from work in 2013.
My parent(s) worked in 2013 but was/were not required to file a tax return. Their 2013 W-2s are enclosed.
Their earnings were: Parent 1: $ ____________________ Parent 2: $______________________
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
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.
Revised 1_31_14
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