2004-2005 Verification Worksheet for Federal Student Aid
Your application was selected for a review in a process called “Verification”. In this process, the school will be comparing information from your application with signed copies of your and your spouse/ parent(s)’ 2003 Federal tax forms, or other financial documents which we will retain in your permanent record. The school must review the requested information, under the financial aid program rules (CFR Title 34, Part 668) before awarding Federal Aid. If there are differences between your application information and your financial documents, you may need to send in corrections on your Student Aid Report (SAR), or your school may send corrections electronically, to have your information processed. Try to complete verification as soon as possible, so that your financial aid won’t be delayed. Your financial aid administrator will help you.
A. STUDENT INFORMATION
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Last name First name M. I Social Security Number
______
Address (include apt. number) Date of birth
______(_____)______
City St. Zip code Phone number
IF dependent, what is your parent’s
marital status (circle one): Single Married Re-married Separated/ Divorce Widowed
IF independent, what is your
marital status (circle one): Single Married Re-married Separated/Divorce Widowed
___ Check here if student/spouse will not file and is not required to file a 2003 Income Tax Return
___ Check here if parent(s) will not file and are not required to file a 2003 Income Tax Return
B. FAMILY INFORMATION:
Give the requested information for the people in your household/family between July 1, 2004 and June 30, 2005.
**If you are a dependent student living away from your parent’s home, include those people who live with parents. Be sure to include your parents on the table below.
Full Name / Age / Relationship / College/UniversitySELF / UTEP
Eligible household members must meet one of the following definitions:
1. Yourself, and your spouse, if you are married (even through common law).
2. Children 18 and under who get more than half of their support from you/spouse.
3. Children 18-23 who attend college or work less than 20 hours a week for whom you/spouse provide half of their support.
4. A dependent’s students siblings who are below 18 years of age, for whom your parents provide more than half of their support.
5. A dependent’s students siblings 18-23 years old who attend college or work less than 20 hours a week for whom your parents provide half of your their support.
6. Your parent(s) or step parents if you are dependent. NOTE: Not being claimed on parent tax returns, not being financially dependent, or not living with parents are not allowed as a basis for considering a student as independent.
FOR OFFICE USE ONLY: FAA: Verification of Household Size Date:
Soc Sec #______/_____/_____
CALENDAR YEAR 2003
Provide the requested amounts for items listed below. Do not leave any space blank (if the item does not apply to you enter zero). Amounts reported should be for 2003 calendar year.
Spouse/ StudentInformation / ITEM / Parent(s) information -only for dependent students
$ / Welfare benefits including TANF. Do not include food stamps or subsidized housing. / $
$ / Social Security benefits that were not taxed (such as SSI). / $
$ / Child support received for all children. Do not include foster care or adoption payments. / $
$ / Payments to tax deferred pension and savings plan (paid directly or withheld from earnings) including, but not limited to, amounts reported on the w-2 form in box 12a thru 12d, codes D, E, F, G, H, and S. / $
$ / Foreign income converted to U.S. currency. * / Father $______
Mother $______
$ / Other untaxed income not reported elsewhere on this form such as housing, food or other living allowances paid to military. Indicate type: ______/ $
$ / Taxable earnings from Federal Work-Study or other need based employment portions of fellowships or assistantships. / $
$ / Student Grant, scholarship, fellowship and assistantship aid, like AmeriCorps awards, that was reported on the income tax form as adjusted gross income. / $
$ / Child support paid because of divorce or separation. Don’t include support for children in your (or your parent’s) household. / $
* Please write the exchange rate at which you converted the currency.
By signing this worksheet, we certify that all the information reported on this worksheet is complete and correct.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
______
Student Signature date Parent signature* Date
*Only for dependent students
The University of Texas at El Paso - Office of Student Financial Aid
202 W. Union Bldg., El Paso, TX 79968-0629 - (915) 747-5204
With few exceptions, you are entitled on your request to be informed about the information the University of Texas at El Paso Collects about you. Under Sections 552.01 and 552.03 of the Texas Government Code, you are entitled to receive and review the information. Under Section 559.004 of the Texas Government Code, you are entitled to have the University of Texas at El Paso correct information about you that is held by that and us is incorrect, in accordance with procedures set forth in the University of Texas System Business Procedures Memorandum 32. The information that the University of Texas at El Paso collects will be retained and maintained as required by Texas records retention laws (Section 441.180 et seq. of the Texas Government Code) and the rules. Different types of information are kept for different periods of time.