Your 2016 -2017 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 reported on your FAFSA. To verify that you provided correct information, we will compare your FAFSA with the information on this institutional verification document
and with any other required documents. If there are differences, your FAFSA information may need to be corrected. If Dependent, you and a parent whose information was reported on the FAFSA
must complete and sign this institutional verification document, attach any required documents, and submit the form and other required documents to us. If Independent, you must complete and
sign this institutional verification document, attach any required documents, and submit the form and other required documents to us. We may ask for additional information. If you have questions
about verification, contact us as soon as possible so that your financial aid will not be delayed.
A. Student's Information
Last Name First Name M.I.
Street Address (include apt. no.) City State Zip Code
ID Number Date of Birth (MMDDYYYY) Email Address Alternate Email Address Home Phone Number Cell Phone Number
Dependent Student Independent Student
B. Parent's and Student's Information to Be Verified:
The student or parents certify that _______________________________________, a member of the student's/parents' household, received benefits from the Supplemental Nutrition Assistance
Program (SNAP) sometime during 2014 or 2015. We may require documentation from the agency that issued the SNAP benefits in 2014 or 2015.
Child Support Paid
If one or both of the parents, or the student and/or spouse, who is a member of the student's household, paid child support in 2015, provide in the space below the names of the persons who
paid the child support, the names of the persons to whom the child support was paid, the names and ages of the children for whom the child support was paid, and the total annual amount of
child support that was paid in 2015 for each child. Note: We may require you to provide additional documentation regarding the child support paid.
Name of Person Who Paid Child Support Name of Person to Whom Child Support was Paid Name and age of Child for Whom Support was paid Annual Amount of Child Support Paid in 2015
Terry Jones $6,000.00
Total Amount of Child Support Paid:
C. Certification and Signatures:
Each person signing below certifies that all of the information reported is
complete and correct.
WARNING: If you purposely give false or misleading information on
this worksheet, you may be fined, sent to prison, or both.
Student's ID Number 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.