(PINK) 15-16 SNAP-Food Stamp Verification Form 2/27/2015
Financial Aid Office P.O. Box 804 Spindale, NC 28160
SNAP/Food Stamp Verification Form – 2015-2016
You must confirm that someone in your household (or in your parent’s household, if dependent) received benefits
from the Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) at any time during the
2013 or 2014 calendar years. Determine members of the household using the information listed below.
Student Name: _____________________________ Student ID# ____________________________
DEPENDENT STUDENT, include:
Yourself
Your parent(s) used on FAFSA, (include step-parent)
Your parent(s)’ other dependent children if:
a) your parent(s) will provide more than half of their support
from July 1, 2015 through June 30, 2016, or b) the children
would be required to provide parental information if filing a
FAFSA
Other people, only if they now live in your parents’
household, and your parents will provide more than half of
their support from July 1, 2015 through June 30, 2016
INDEPENDENT STUDENT, include:
Yourself
Your spouse (if you are married)
Your children, if you will provide more than half of
their support from July 1, 2015 through June 30,
2016
Other people, only if they live in your household and
you provide more than half of their support and will
continue to do so from July 1, 2015 through June 30,
2016
Yes, a member of my household (or of my parent’s household, if dependent) and/or I received SNAP
benefits in 2013 or 2014. If asked, I will provide documentation of the receipt of SNAP benefits during 2013
and/or 2014.
No, no one in my household (or in my parent’s household, if dependent) received SNAP benefits in
2013 or 2014.
Certification and Signature
Each person signing below certifies that all of the
information reported is complete and correct.
________________________________________ ________________________
Student’s Signature Date
___________________________________ ________________________
Parent’s Signature (Required if Dependent) Date
WARNING: If you purposely give false or
misleading information you may be fined,
sentenced to jail, or both.
