SUBMIT FORM TO: Financial Aid Office | finaid@eastcentral.edu | fax 636-583-6651 | call 636-584-6588 | 1964 Prairie Dell Road, Union, MO 63084
2019-20
FAFSA VERIFICATION WORKSHEET
V5
LAST NAME FIRST NAME STUDENT ID # SOCIAL SECURITY # DATE OF BIRTH PHONE NUMBER
Submit to the Financial Aid Office in-person, at your campus, or via the email, fax, or mailing address listed at the bottom of this page within 30 days after
notification. If more space is needed for any line item on this form, provide a separate page that includes the student's name and ID number at the top.
SECTION 1 -- NUMBER OF HOUSEHOLD MEMBERS AND NUMBER IN COLLEGE
INSTRUCTIONS FOR DEPENDENT STUDENTS: <-----------(or)----------->
List below the people in the parent's household. Include:
§ The student & parents (including a stepparent) even if the student doesn't live with the parents.
§ The parent's other children if the parents will provide more than half of their support from July
1, 2019, through June 30, 2020, or if they would be required to provide parental information if
they were completing a 2019-2020 FAFSA. 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 between
July 1, 2019 through June 30, 2020.
INSTRUCTIONS FOR INDEPENDENT STUDENTS:
List below the people in the student's household. Include:
§ The student & if the student is married, the student's spouse.
§ The student's or spouse's children if the student or spouse will provide
more than half of the children's support from July 1, 2019, through
June 30, 2020, even if the child does not live with the student.
§ Other people if they now live with the student and the student or
spouse provides more than half of the other person's support and will
continue to provide more than half of that person's support through
June 30, 2019.
Number in College: Also Include in the space below information about any household member (see above for definitions) who is, or will be, enrolled at least half time in a
degree, diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, 2019, and June 30, 2020, include the name of the college.
FIRST NAME M.I. LAST NAME AGE RELATIONSHIP COLLEGE
Will be enrolled at least
Half Time? (Yes or No)
EAST CENTRAL COLLEGE
SECTION 4 -- TAXES (Check the box for student and, if applicable, spouse or parent(s) that applies to the statement to the right)
STUDENT
SPOUSE
(if married)
PARENT 1
(if dependent)
PARENT 2
(if dependent)
Filed a 2017 Federal Tax Return with the IRS and 'linked' taxes using the IRS
Data Retrieval Tool in the FAFSA or provided a signed copy of the 2017 Tax
Return Date linked:____________
STUDENT
SPOUSE
(if married)
PARENT 1
(if dependent)
PARENT 2
(if dependent)
Will not file and are not required to file a 2017 income tax return with the IRS, but WAS EMPLOYED in
2017 = Parent(s) and Independent Student(s) must provide the 2017 IRS "Verification of non-filer letter"
and ALL 2017 W2's. Dependent Student(s) must list all sources of 2017 income below.
STUDENT
SPOUSE
(if married)
PARENT 1
(dep. student)
PARENT 2
(if dependent)
Will not file and are not required to file a 2017 income tax return with the IRS, WAS NOT EMPLOYED in
2017 = Parent(s) and Independent Student(s) must submit the 2017 IRS "Verification of non-filer letter".
FOR NON-TAX FILERS: List the name of each employer, the amount earned from each employer in 2017, & whether an IRS W-2 form is provided.
List every employer even if they employer didn't issue an IRS W-2 form. Review eCentral to confirm all documents needed for verification.
STUDENT/SPOUSE 2017 INCOME FROM WORK
W2 attached?
PARENT(S) 2017 INCOME FROM WORK
W2 attached?
Source: $ Source: $
Source: $ Source: $
Source: $ Source: $
Total Amount of Income Earned from Work
$
Total Amount of Income Earned from Work
$
Certification & Signature:
EACH PERSON SIGNING
CERTIFIES THAT ALL OF THE
INFORMATION REPORTED
X_____________
STUDENT SIGNATURE
____
DATE
X_____________
PARENT SIGNATURE (if a dependent student)
____
DATE
IS COMPLETE & CORRECT
Warning: If you purposely give false or misleading information, you may be fined, be sentenced to jail, or both.
SUBMIT FORM TO: Financial Aid Office | finaid@eastcentral.edu | fax 636-583-6651 | call 636-584-6588 | 1964 Prairie Dell Road, Union, MO 63084
2019-20
FAFSA VERIFICATION WORKSHEET
V5
Identity and Statement of Educational Purpose
You, the student, must appear in person at East Central College to verify your identity by presenting an unexpired valid
government-issued photo identification (ID), such as, but not limited to, a driver's license, other state-issued ID, or
passport. ECC will maintain a copy of your photo ID that is annotated with the date it was received & reviewed & the
name of the official at the institution authorized to collect your ID. In addition, you must sign, in the presence of the
institutional official, the following Statement of Educational Purpose.
ONLY to be signed AT THE INSTITUTION or in the presence of a Notary Public
AUTHORIZED COLLEGE OFFICIAL: STUDENT:
Copy student unexpired valid government-issued photo ID AT THE
TIME of their signing the Statement & annotate that copy with your
name & the date, verifying student identity. You may place it below &
make a copy:
_____________________________________ __________________
AUTHORIZED OFFICIAL NAME DATE
Statement of Educational Purpose
I certify that I __________________________
(Print Student's Name)
am the individual signing this Statement of
Educational Purpose and that the Federal
student financial assistance I may receive will
only be used for educational purposes and to
pay the cost of attending East Central College
for 2019-2020.
______________________________________
(Student's Signature)
__________________ ___________________
(Date) REQUIRED: (Student's ID#)
If you're unable to be present at East Central College: Notary's Certificate of Acknowledgement (below)
If you, the student, are unable to appear in person at East Central College to verify your identity, you must provide:
(a) A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged in the notary statement below,
or that is presented to a notary, such as, but not limited to, a driver’s license, other state-issued ID, or passport; and
(b) The original Statement of Educational Purpose provided above, which must be notarized. If the notary statement appears on a
separate page than the Statement of Educational Purpose, there must be a clear indication that the Statement of Educational
Purpose was the document notarized.
THIS STATEMENT & COPY OF ID MUST BE SUBMITTED TO EAST CENTRAL COLLEGE IN ORIGINAL PAPER FORM.
State of ____________________ City/County of________________________ On (date)__________________, before me,
(Notary's name) ___________________________________, personally appeared, (Printed name of signer)
______________________________, and proved to me on basis of satisfactory evidence of identification
___________________________________ to be the above-named person who signed the foregoing instrument.
(Type of unexpired government-issued photo ID provided)
WITNESS my hand and official seal
(seal) __________________________________
(Notary signature)
My commission expires on _________________
(Date)
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