Fillable Form 1: 20192020 Custom Verification Worksheet V4-Dependent Student

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Form 1: 20192020 Custom Verification Worksheet V4-Dependent Student

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2019–2020 Custom Verification Worksheet
V4-Dependent Student
Your 2019–2020 Free Application for Federal Student Aid (FAFSA) was selected for review in a
process called “Verification”. The Financial Aid Office at your college must compare information
from your FAFSA with information you provide on this worksheet and with any other required
documents. If there are differences, your Financial Aid Office may require additional
documentation and your FAFSA information may need to be corrected. You will not receive federal
financial aid until all verification requirements are met and the necessary corrections made.
What You Should Do
1
. Complete Section A of this worksheet – you and one of your parents must sign the Section
B certification at the bottom of the page.
2. Collect the documents required for Section C on page 2 but do NOT complete that section in
advance.
3. Submit the completed worksheet and any other required documents to the Financial Aid
Office at your college. You will complete Section C in person at that time.
A. Student’s Information
Student’s Last Name First Name M.I.
Student’s Social Security Number
Student’s Street Address (include apt. no.)
Student’s CUNYfirst ID / Empl ID
City, State, Zip Code
Student’s Date of Birth
Student’s Phone Number (include area code)
Student’s Email Address
B. Certification and S ignatures – Student and one parent must sign
W
e certify that all of the information reported on this worksheet is complete and correct. We
understand that if we purposely give false or misleading information, we could be fined, jailed,
or both.
Student Signature
Date
Parent Signature
Date
Do not mail this worksheet to the U.S. Department of Education.
Submit this worksheet to the Financial Aid Office at your college.
You should make a copy of this worksheet and all submitted documents for your records.
You must complete Section C on page 2 of this worksheet IN PERSON at the Financial Aid
Office at your college.
2019-20 Custom Verification Worksheet V4-Dependent Student Page 1 of 2
Student Name:
Student SSN: XXX-XX- ____ ____ ____ ____
C. Identity Verification and Statement of Educational Purpose
Do not complete this page in advance. You must complete and sign this page IN PERSON
at the Financial Aid Office at your college.
You have been selected by the U.S. Department of Education to verify your identity and
educational plans. You must appear in person at the Financial Aid Office at your college and
present a piece of valid government-issued identification to a financial aid representative. The
representative will review and copy this piece of identification which will be maintained in your
student file.
Statement of
Educational Purpose
I c
ertify that I, ___________________________________________________________________
(Print Name)
am the individual signing this 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
________________________________________________________________ for 2019-2020.
(Name of CUNY Institution Attending)
Student’s Signature: ___________________________________ Date: ____________________
OFFICE USE ONLY- DO NOT WRITE BELOW
1. Proof of Identity
The above-named student has appeared in person and presented an unexpired valid
government
issued photo identification such as, but not limited to, a state driver’s license,
non-driver’s
identification card, other State-issued identification, or U.S. passport which verifies his or
her
identity.
NOTE: An unexpired valid government-issued photo identification is one issued by the
U.S.
government, any of the 50 States, the District of Columbia, the Commonwealth of Puerto Rico,
a
federally recognized American Indian and Alaska Native Tribe, or other U.S. territory as outlined
in
the Federal
Register.
FA Certifying Officer’s Signature
Type of Valid ID Collected
2. Completion of High School or the Equivalent
The above-named student has submitted a final high school transcript or other acceptable
documentation to the appropriate CUNY office that shows evidence of graduation from an
accredited high school or educational institution, state-issued general education equivalency (GED),
or evidence of home schooling.
FA Certifying Officer’s Signature
Date Received
2019-20 Custom Verification Worksheet V4-Dependent Student Page 2 of 2
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Form 1: 20192020 Custom Verification Worksheet V4-Dependent Student

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Completed 26 July 2020

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