Fillable Verification V5 Dependent (Eastern Wyoming College)

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Verification V5 Dependent (Eastern Wyoming College)

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The Verification V5 Dependent (Eastern Wyoming College) form is 5 pages long and contains:

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  • 6 check-boxes
  • 151 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Eastern Wyoming College

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STUDENT INFORMATION
Hand deliver or mail original:
Financial Aid Office
Eastern Wyoming College
3200 West C Street
Torrington, WY 82240
FAMILY INFORMATION
CHILD SUPPORT PAID
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)/FOOD STAMPS
2014-2015
Dependent V5 Worksheet
(Aggregate Verification)
Your application has been selected for review in a process called “Verification”. In this process, the information from your Free
Application for Federal Student Aid (FAFSA) will be compared with your and your parent(s)’ Federal IRS tax information as well as
other financial 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 all required documents and submit to the Financial Aid Office at EWC.
__________________________________________________________ ____ __________________________________________
Last Name First Name M.I. EWC Student ID Number
______________________________________________________________ __________________________________________
Address (include apartment number) Social Security Number (last four digits)
______________________________________________________________ __________________________________________
City, ST, Zip Phone Number (include area code)
Fill in the information below about the people your parent(s) will support between July 1, 2014 and June 30, 2015. INCLUDE
YOURSELF, YOUR PARENT(S) (including step-parent), YOUR SIBLINGS AND ANY OTHERS WHO RECEIVE MORE THAN
HALF OF THEIR SUPPORT FROM YOUR PARENT(S). Include siblings who are enrolled in college at least half time (six credits)
and who are also considered dependent for FAFSA purposes. List the name of the college others will be attending if they are enrolled
in a degree, diploma, or certificate program for at least six credits per term between July 1, 2014 and June 30, 2015.
Full name of household member
Age
Relationship to student
College attending
Self EWC
Did anyone in your parent’s household (listed above) receive benefits from the Supplemental Nutrition Assistance Program or SNAP
(formerly food stamps) in 2012 OR
2013?
No Yes If asked by my school, I will provide documentation of the receipt of SNAP benefits during 2012 and/or 2013.
Did anyone in your household PAY child support in 2013 for any children NOT listed above as a household member?
No Yes If “yes”, complete box below. If asked by my school, I will provide documentation of child support payment.
Name of person who
PAID child support
Name of person to whom
child support was paid
Name of child for whom
child support was paid
amount of child
Over
INCOME VERIFICATION
PARENT(S)’ INCOME
STUDENT INCOME
UNTAXED INCOME INFORMATION
The easiest way to verify income is to use the IRS Data Retrieval Tool when completing or updating your FAFSA on the federal web
site. If you did not use the IRS Data Retrieval Tool when completing or updating the FAFSA, you must provide an IRS Tax Return
Transcript. Due to changes in federal regulations, schools can no longer accept photocopies of tax returns. To request an IRS
Tax Return Transcript please visit www.irs.gov/Individuals/Get-Transcript
to download and print your transcript
immediately, or request the transcript be mailed to your address on record. Be sure to request a Tax Return Transcript, NOT an
Account Transcript. If you or your parent(s) did not and will not file a 2013 Federal tax return, please check the appropriate box
below. Please provide W-2 forms if you worked, but were not required to file a tax return.
I used the IRS Data Retrieval process to transfer my 2013 IRS income tax return information when completing/updating my
2014-2015 FAFSA.
My signed 2013 Federal IRS Tax Return Transcript(s) is attached. (Foreign tax return filers may submit signed photocopies.)
See Income Verification section above for important details.
I was not employed and had no income earned from work in 2013.
I worked in 2013 but was not required to file a tax return. My 2013 W-2s are enclosed. My earnings were: $______________
If you received income earned from the Federal Work-Study Program, need-based employment portions of fellowships and
assistantships, or a cooperative education program offered by a college in 2013, write in the type and amount you actually
included on your 2013 Federal tax return: Type: __________________________________________ $______________
My parent(s) used the IRS Data Retrieval process transfer their 2013 IRS income tax return information when
completing/updating my 2014-2015 FAFSA.
My parent(s)’ signed 2013 Federal IRS Tax Return Transcript(s) is/are attached. (Foreign tax filers may submit signed
photocopies.) See Income Verification section above for important details.
My parent(s) were not employed and had no income earned from work in 2013.
My parent(s) worked in 2013 but was/were not required to file a tax return. Their 2013 W-2s are enclosed.
Their earnings were: Parent 1: $ ____________________ Parent 2: $______________________
Fill in the information below as it applies to the student AND the student’s parent(s) whose information is on the FAFSA.
DO NOT LEAVE ANY ITEM BLANK. If any item does not apply, enter “N/A” for Not Applicable where a response is requested,
or enter $0 in an area where an amount is requested.
ALL AMOUNTS ARE ANNUAL. To determine the correct annual amount for each item: If you paid or received the same dollar
amount every month in 2013, multiply that amount by the number of months in 2013 you paid or received it. If you did not pay or
receive the same amount each month in 2013, add together the amounts you paid or received each month.
If more space is needed for any item, attach a separate page with student’s name, ID # and appropriate information.
A. Payments to tax-deferred pension and retirement savings
List any payments (direct or withheld from earnings) to tax-deferred pension and retirement savings plans, including, but not limited to,
amounts reported on W-2 forms (Boxes 12a through 12d with codes D, E, F, G, H, and S). Copies of all W-2 forms must be attached
.
Name of person who made payment
Total amount paid in 2013
Self
2/12/14
continue
B. Child support received
List the actual amount of any child support RECEIVED in 2013 for any children listed as a household member?
Name of adult who received
the child support payment
Name of child for whom
child support was paid
Total annual amount of child
support received in 2013
C. Housing, food, and other living allowances paid to members of the military, clergy, and others
Include cash payments and/or the cash value of benefits received.
Name of recipient Type of benefit received
Total amount of benefit
received in 2013
D. Veterans non-education benefits
List the total amount of veterans non-education benefits received in 2013. Include Disability, Death Pension, Dependency and
Indemnity Compensation (DIC), and/or VA Educational Work-Study allowances. DO NOT include federal veterans educational
benefits such as: Montgomery GI Bill, Dependents Education Assistance Program, VEAP Benefits, Post-9/11 GI Bill.
Name of recipient
Type of Veterans
non-education benefit received
Total amount of benefit
received in 2013
E. Other untaxed income
List the amount of other untaxed income not reported and not excluded elsewhere on this form. Include items such as disability,
workers’ compensation, Black Lung Benefits, untaxed portions of health savings accounts from IRS Form 1040 Line 25, Railroad
Retirement Benefits, etc.
DO NOT include student aid, Earned Income Credit, Additional Child Tax Credit, Temporary Assistance to
Needy Families (TANF), untaxed Social Security benefits, Supplemental Security Income (SSI), Workforce Investment Act (WIA)
educational benefits, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion, or
credit for federal tax on special fuels.
Name of recipient
Type of other
untaxed income received
Total amount of other untaxed
income received in 2013
F. Money received or paid on the student’s behalf
List any money received or paid on the student’s behalf (e.g., payment of a bill) not reported elsewhere on this form. Include support
from a parent whose information was NOT on the student’s FAFSA, but DO NOT include information from a parent whose
information IS included on the FAFSA. Amounts paid on the student’s behalf also include any distributions to the student from a 529
plan owned by someone other than the student or student’s parents
, such as grandparent, aunts and uncles of the student.
Purpose (e.g., cash, rent, books,
cell phone bill, car insurance, etc.)
Source of payment (parent NOT on
FAFSA, grandparent, etc.)
Total amount received
received in 2013
G. Additional information
So that we may fully understand the student’s family’s financial situation, please provide below information about any other resources,
benefits, and other amounts received by the student and any members of the student’s household. This may include items that were not
required to be reported on the FAFSA or other forms submitted to the financial aid office, and include such things as federal veterans
education benefits, military housing, low-income housing, SNAP, TANF, WIC, Supplemental Security Income, etc.
Purpose (e.g., cash, rent, books,
cell phone bill, car insurance, etc.)
Source of payment (parent NOT on
FAFSA, grandparent, etc.)
Total amount received
received in 2013
HIGH SCHOOL COMPLETION STATUS
CERTIFICATIONS AND SIGNATURES
Additional explanation of how your family supported itself in 2013: _____________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Please provide ONE of the following documents that indicates your high school completion status when you will begin college in
2014-2015 and submit it with this form and any other documentation requested.
A copy of your high school diploma.
Your final official high school transcript that shows the date when the diploma was awarded.
Your official General Educational Development (GED)* certificate or transcript.
Documentation of the HiSET or other high school equivalency exam is also acceptable.
An official academic transcript that indicates you successfully completed at least a two-year
program that is acceptable for full credit toward a bachelor’s degree.
Please note: Credits transferred in from previous institutions attended may affect your maximum
time frame calculation as defined in EWC’s Satisfactory Academic Progress Policy.
If you were home schooled in Wyoming, a copy of your transcript or the equivalent, signed by a parent
or guardian, along with EWC’s Completion of Secondary Education Form for Home Schooled Students.
If you were home schooled in another state and your state requires home schooled students to obtain a
secondary school completion credential for home school (other than a high school diploma or its
recognized equivalent), a copy of that credential.
If you are unable to obtain any of the forms of documentation listed above, please contact the Financial Aid Office.
By signing this worksheet, we certify that all of the information reported is complete and correct. We also acknowledge that we have
read and agree to comply with all verification policies as stated by EWC. Failure to submit information in a timely fashion may
result in the application being filed as inactive with no further consideration and no federal aid for the academic year. Student and
one parent must sign:
___________________________________________________ _____________________________________________________
Student’s signature Date Parent’s signature Date
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
COMPLETE ATTACHED FORM ALSO—READ DIRECTIONS CAREFULLY
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2014-2015 IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE
The student must verify his or her identity by presenting a valid government-issued photo identification (ID), such as, but
not limited to, a driver’s license, other state-issued ID, or passport.
The institution will maintain a copy of the student’s
photo ID that is annotated with the date it was received and the name of the official at the institution authorized to
collect the student’s ID.
In addition, the following statement MUST be completed and signed in the presence of either a Financial Aid Administrator
at Eastern Wyoming College, an Outreach Coordinator at EWC or a Notary Public.
DO NOT COMPLETE THIS FORM IN ADVANCE.
Statement of Educational Purpose
I certify that I __________________________________________________ am the individual signing this
(print student’s name)
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 Eastern Wyoming College for 2014-2015.
Student signature:
Date: Student ID #:
Declaración de Propósito Educativo
Certifico que yo, __________________________________________________ soy el individuo que firma esta
(Imprimir Nombre del Estudiante)
Declaración de Finalidad Educativa y que la ayuda financiera federal estudiantil que yo pueda recibir, sólo será
utilizada para fines educativos y para pagar el costo de asistir a Eastern Wyoming College para 2014-2015.
Firma del Estudiante:
La Fecha: ________________________ Número de Identificaciôn del Estudiante:___________________
IF SUBMITTING IN PERSON
Present this form with original valid government-issued photo ID,
s
uch as, but not limited to, a driver’s license, other state issued ID, or
passport.
IF SUBMITTING BY MAIL
Submit this original notarized form with photocopy of valid
government-issued photo ID to EWC.
To be completed by EWC Financial Aid Administrator
or EWC Outreach Coordinator (FAA/OC):
To be completed by Notary Public:
ID Type:
State of: City/County of:
ID Number:
Exp:
On (date):
Before me:
(notary’s name)
FAA/OC Name:
Personally appeared (printed name of signer):
FAA/OC Title/location:
On basis of satisfactory evidence of identification:
(Type of government-issued photo ID provided)
FAA/OC Signature:
Date:
To be the above-named person who signed the
foregoing instrument.
Notary signature:
WITNESS my hand and official seal:
My commission expires on: ________________________
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Verification V5 Dependent (Eastern Wyoming College)

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Completed 25 July 2020

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