DEPENDENT VERIFICATION FORM
201
8
-201
9
Financial Aid Office/Enrollment Services
452 South Anderson Road, Rock Hill, South Carolina 29730
Phone (803) 327-8008 Fax (803) 981-7278
A l l s e c t io n s m u st b e c o m p le te d .
Student Name CID
A.
Number of Household Members
List below the people in the parents’ household. Include:
The student.
The parents (including a stepparent) even if the student doesn’t live with the parents.
The parents’ other children if the parents will provide more than half of the children’s support from
July 1, 201
8
- June 30, 201
9
, or if the other children would be required to provide parental
information if they were completing a FAFSA for 201
8
–201
9
. Include children who meet either of
these standards even if the children do not live with the parents.
Other people if they now live with the parents and the parents provide more than half of the other
people’s support and will continue to provide more than half of their support through June 30, 2019.
Full Name
Age
Relationship to Student
Self
B.
Number in College
Include below information about any household member, excluding the parents, who will be enrolled at least half
time in a degree, diploma, or certificate program at an eligible postsecondary educational institution anytime
between July1, 201
8
, and June 30, 2019. Include the name of the college. (Undergraduate only)
Name of Student
Name of College
York Technical College
1
C.
Verification of 2016 Income Information for Pa
rents
Check ONE box.
We used the IRS Data Retrieval Tool to import data into the FAFSA.
We have attached the tax return transcript for 201
6
to this form.
We did not file a tax return for 201
6
and did not have any income from working.
We did not file a tax return for 201
6
, but we have attached W2 forms.
D.
Verification of 2016 Income Information for Student
Check ONE b
ox.
We used the IRS Data Retrieval Tool to import data into the FAFSA.
We have attached the tax return transcript for 201
6
to this form.
We did not file a tax return for 201
6
and did not have any income from working.
We did not file a tax return for 201
6
, but we have attached W2 forms.
G.
Certification and Signatures
Each person signing below certifies that all of the
information reported is complete and correct.
The student and one parent whose information was
reportedontheFAFSA must signand date.
WARNING: If y ou purposely give false or
misleading information you maybe fined,
be sentenced to ja il, o r both.
2
_
Student’s Signature (Required) Date
_
Date
Parent’s Signature (Required)