2017
-
2018
Verification W
o
r
ksh
ee
t
Dependent Student - Tracking Group V
4
Your 20172018 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. Before awarding
Federal
Student Aid, you must confirm the information you and your parents reported on your FAFSA. We will compare your FAFSA with the
information on this worksheet and with any other required documents. If there are differences, your FAFSA information may need to be
corrected. You and at least one parent must complete and sign this worksheet, attach any required documents, and submit the form and other
required documents to the financial aid office. Additional information may be required to resolve conflicting information.
A. Dependent Students Information
Students Last Name Students First Name MI Students SSN or ID Number
Students Street Address (include apt. no.) Students Date of Birth
City State Zip Students Email Address
Students Phone Number Students Alternate or Cell Phone Number
B. High School Completion Status
Provide one of the following documents that will indicate the students high school completion status when the student begins college in 2017-
2018:
Check the box of the document you will attach to this worksheet:
A copy of the students high school diploma.
A copy of the students final official high school transcript that shows the date when the diploma was awarded.
A state certificate or transcript received by a student after the student passed a State-authorized examination (GED test, HiSET, TASC, or other
State-authorized examination) that the State recognizes as the equivalent of a high school diploma.
For students who completed secondary education in a foreign country, a copy of the “secondary school leaving certificateor other similar
document.
An academic transcript that indicates the student successfully completed at least a two-year program that is acceptable for full credit toward
a bachelors degree.
For a homeschooled student in a state where state law requires the student to obtain a secondary school completion credential for
homeschool (other than a high school diploma or its recognized equivalent), a copy of that credential.
For a homeschooled student from a state where state law does not require the student to obtain a secondary school completion credential
for homeschool (other than a high school diploma or its recognized equivalent), a transcript or the equivalent, signed by the student's
parent or guardian, that lists the secondary school courses the student completed and includes a statement that the student successfully
completed a secondary school education in a homeschool setting.
A student who is unable to obtain the documentation listed above must contact the financial aid office.
C. Identity and
Statement
of
Educational
Purpose
Section C is ONLY to be completed in person at the Institution or in front of a Notary.
3
Student Name___________________________________ Student ID#_______________
The student must appear in person at
(Name of Postsecondary Education Institution)
to verify his or her identity by presenting a valid government-issued photo identification (ID), such as, but not limited to, a drivers license, other
state-issued ID, or passport. The institution will maintain a copy of the students photo ID that is annotated by the institution with the date it was
received and reviewed and the name of the office at the institution authorized to collect the students ID. In addition, the student must sign, in the
presence of the institutional official, the Statement of Education Purpose provided below. If you cannot appear in person to sign this Statement
of Educational Purpose, you will need to provide a copy of your government issued ID and this Statement of Educational Purpose notarized by a
public notary.
Statement of Education Purpose
I certify that I am the individual signing this Statement of Educational Purpose and that
the
Printed Students Name
Federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending
(Name of Postsecondary Educational Institution)
for 2017-2018.
Students Signature Date Financial Aid Administrators Signature Date
Notarys Certificate of Knowledge
S
tate
of Ci
ty
/Coun
ty
of On
before me, personally appeared,
(Notarys Name) (printed name of signer)
Notary’s Signature
(Date Commission Expi
re
s)
(Seal)
D. Certification and Signatures
Each person signing this worksheet certifies that all of the information reported on it is complete and correct. WARNING: If you purposely give
false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
The student and one parent must sign and date.
Students Signature Date
Parents Signature Date
Do not mail this worksheet to the U.S. Department of Education. Submit this worksheet to the financial aid
administrator
at your
school.
You should make a copy of this worksheet for your
records.
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
2017-18 INCOME/EXPENSE CERTIFICATION (GRANT RECIPIENT)
STUDENT INCOME (AND SPOUSE) 2015 INCOME INFORMATION
Please list all income and cash support that you received from January 2015 through December 2015. Include untaxed
earnings that are not reported on your federal income tax return (if you are required to file). If you are married, you MUST
list your spouse's income information.
SOURCE OF INCOME
ANNUAL AMOUNT
WAGES
SPOUSE/PARTNER WAGES
UNTAXED INCOME
BENEFITS PROGRAM
FINANCIAL AID
PERSONAL BILLS PAID ON MY
BEHALF
VETERANS NONEDUCATIONAL
BENEFITS
TOTAL INCOME
STUDENT (AND SPOUSE) 2015 EXPENSE INFORMATION
Please list all of your expenses from January 2015 through December 2015. If you are married, you MUST list your
spouse's expense information.
MONTHLY AMOUNT
ANNUAL AMOUNT
RENT/MORTGAGE
UTILITIES
FOOD
TRANSPORTATION
CLOTHING
ENTERTAINMENT
OTHER
TOTAL EXPENSES
I hereby certify that all the above information is true, complete and correct. I understand that by providing false
information, I may lose financial aid eligibility which may result in my owing GGU for whatever costs I may have
already incurred.
STUDENT SIGNATURE DATE
Golden Gate University Financial Aid Office Last Revision: 11/09/2016
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
click to sign
signature
click to edit
2017-18 INCOME/EXPENSE CERTIFICATION (GRANT RECIPIENT)
Please select the appropriate box for the following questions:
a) Do you have a parent or guardian that was a member of the armed forces and died as a result of military service in
Iraq or Afghanistan after 9/11/2001?
Yes No * Declined to Answer
b) Were you less than 24 years of age or enrolled as a student at an institution of higher education at the time of your
parent/guardian's death?
Yes No * Declined to Answer
c) Student who is subject to involuntary civil commitment upon completion of a period of incarceration for a forcible or
non-forcible sexual offense is ineligible to receive a Pell Grant.
Does this apply to you?
Yes No * Declined to Answer
*Checking this box will make you ineligible to receive Pell or FSEOG Grants per federal regulations
As an eligible Pell Grant and/or FSEOG recipient, per federal regulations you must complete a review process called
"Verification" to receive your award. If you stated in your FAFSA that you have Zero income, reported very little
income to support yourself and/or your dependent(s), or were otherwise unable to complete on Page 1 of this form,
please explain below how you supported yourself and/or your dependent(s) in the past year:
I hereby certify that the information provided in this document is true and correct. I also understand that I may lose
my eligibility if I give false or misleading information.
Student Name Student Signature Date
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
To be completed by any person or persons who provided in-kind support to the student:
I hereby certify that the above statement is true and that I have provided in-kind support to the above student:
Name Signature Date
(Please attach a copy of the driver's license or signature ID of person who provided in-kind support)
Golden Gate University Financial Aid Office Last Revision: 11/09/2016
click to sign
signature
click to edit
click to sign
signature
click to edit