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SOUTHEASTERN COMMUNITY COLLEGE
FINANCIAL AID OFFICE
2020-21 DEPENDENT STUDENT VERIFICATION OF HOUSEHOLD MEMBERS
Your 2020-2021 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that before
awarding Federal Student Aid, we may ask you to confirm the information you and your parents reported on your FAFSA. To verify that you
provided correct information, 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. SCC may ask for additional information. If you
have questions about verification, contact the Financial Aid Office as soon as possible so that your financial aid will not be delayed.
A. Dependent Student’s Information
____________________________________________________ ________________________________ ______________________
Student’s Last Name Student’s First Name Student’s M.I. Student’s ID or Social Security Number Student’s Date of Birth
___________________________________________________________________________________________________
Student’s Street Address (include apt. no.) City, State and Zip Code
___________________________________________________________
Student’s Email Address
_________________________________________ ___________________________________
Student’s Home Phone Number (include area code) Student’s Alternate or Cell Phone Number
B. As of today, what is the marital status of your legal parents:
____ Single ____ Married/Remarried ____ Separated ____ Divorced/Widowed ____ Unmarried, with both parents living together
** Date of any marital status change: ___________________
C. Dependent Student’s Family Information
List below the people in your parent(s)’ household. Include:
Yourself and your parent(s) (including a stepparent) even if you don’t live with your parent(s).
Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2020, through June 30, 2021,
or if the other children would be required to provide parental information if they were completing a FAFSA for 2020-2021. Include
children who meet either of these standards, even if they do not live with your parent(s).
Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will continue to
provide more than half of their support through June 30, 2021.
Include the name of the college for any household member, excluding your parent(s), who will be enrolled, at least half time in a degree,
diploma, or certificate program at a postsecondary educational institution any time between July 1, 2020, and June 30, 2021. If more space
is needed, attach a separate page with the student’s name and Social Security Number at the top.
Full Name Age Relationship College Will be Enrolled at
Least Half Time
Self Southeastern Community College
D.
Certification and Signatures: Each person signing this worksheet certifies that all of the information reported on it is complete
and correct. The student and parent must sign and date.
__________________________________________________________
Student’s Signature and Date
__________________________________________________________
Parent’s Signature and Date
WARNING: If
ou
ur
osel
ive false or misleadin
information on this worksheet
ou ma
be fined
be sentenced to
ail
or both.
