2014-15 DEPENDENT
Verification Form
Your 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. THIS DOCUMENT IS A FORM - PLEASE TYPE YOUR INFORMATION IN THE GRAY AREAS PROVIDED. USE THE “TAB” KEY ON YOUR KEYBOARD TO MOVE TO THE SPACES PROVIDED – DO NOT USE THE “ENTER” KEY.
PLEASE REFER TO THE NOTICE YOU RECEIVED FROM OUR OFFICE TO DETERMINE WHICH SECTION TO COMPLETE
THIS FORM CONTAINS SECTIONS A THRU F. YOU ARE NOT REQUIRED TO COMPLETE ALL SECTIONS
SECTION A:
First Name: / Last Name: / SS#: X X X – X X -FULL Mailing Address:
Phone: / Email:
HOUSEHOLD INFORMATION:
List the people in the space provided below that your parents will support between July 1, 2014 and June 30, 2015. Include yourself, your parents (including a step parent), and your parent’s dependent children (if your parents provide more than half their support or if they would be required to give parental information when applying for Federal Student Aid). 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 institution.
Name / Age / Relationship / College Attending (if applicable)SELF / Western Dakota Tech
Source(s) If $0 income, type below “I had no income in 2013” / 2013 Amount
$
$
NOTE: RIGHT CLICK ON THE NUMBER
TO THE LEFT, AND SELECT
UPDATE FIELD TO TOTAL THE COLUMN / $ 0.00
STUDENT:
IF YOU DID NOT file a 2013 federal income tax return,
mark this box, attach your W-2 forms and COMPLETE SOURCES OF INCOME SECTION
OR
IF YOU FILED a 2013 federal income tax return, mark this box.
Source(s) If $0 income, type below “I had no income in 2013” / 2013 Amount$
$
$
NOTE: RIGHT CLICK ON THE NUMBER
TO THE LEFT, AND SELECT
UPDATE FIELD TO TOTAL THE COLUMN / $ 0.00
PARENTS:
If you DID NOT file a 2013 federal income tax return.
Mark this box, attach your W-2 forms and COMPLETE SOURCES OF INCOME SECTION
OR
IF YOU FILED a 2013 federal income tax return, mark this box.
One of the persons listed in the Household Information above received SNAP benefits, formerly known as Food Stamps in 2012 or 2013?
Yes (REQUIRED – you must submit proof of your receipt of SNAP – letter or printout from agency listing year(s) received or other verifiable proof) No
In 2013 child support was paid by someone in the Household? Yes (Complete Child Support section below) No
Name of Person who PAID Child Support / Name of Person who RECEIVED Child Support / Name of Child the Support Was For / Total Amt$
$
If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both. Our signatures certify this information is correct.
Student Signature Date / Parent Signature DateNOTICE: This form must be submitted to our office within 14 days of this request. If the required documentation is not received, we cannot continue processing your application for financial aid. Processing will not resume until/unless the necessary information/documents are provided. If the 14-day time period extends to or beyond registration day, you must either pay the institutional costs from personal funds, or request a payment plan from the Student Accounts Office.
IF YOU WERE REQUIRED TO COMPLETE SECTION A, PLEASE SIGN, DATE AND SUBMIT THIS SHEET ONLY YOU MUST HAVE ACCESS TO A PRINTER IN ORDER TO PRINT AND SUBMIT THIS FORM
Your 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. THIS DOCUMENT IS A FORM - PLEASE TYPE YOUR INFORMATION IN THE GRAY AREAS PROVIDED. USE THE “TAB” KEY ON YOUR KEYBOARD TO MOVE TO THE SPACES PROVIDED – DO NOT USE THE “ENTER” KEY.
SECTION B:
First Name: / Last Name: / SS#: X X X – X X -FULL Mailing Address:
Phone: / Email:
Someone in my household received SNAP benefits, formerly known as Food Stamps in 2012 or 2013?
Yes (REQUIRED – you must submit proof of your receipt of SNAP – letter or printout from agency listing year(s) received or other verifiable proof) No
If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both. Our signatures certify this information is correct.
Student Signature Date / Parent Signature DateNOTICE: This form must be submitted to our office within 14 days of this request. If the required documentation is not received, we cannot continue processing your application for financial aid. Processing will not resume until/unless the necessary information/documents are provided. If the 14-day time period extends to or beyond registration day, you must either pay the institutional costs from personal funds, or request a payment plan from the Student Accounts Office.
IF YOU WERE REQUIRED TO COMPLETE SECTION B, PLEASE SIGN, DATE AND SUBMIT THIS SHEET ONLY
SECTION C:
First Name: / Last Name: / SS#: X X X – X X -FULL Mailing Address:
Phone: / Email:
In 2013 child support was paid by someone in the Household? Yes (Complete Child Support section below) No
Name of Person who PAID Child Support / Name of Person who RECEIVED Child Support / Name of Child the Support Was For / Total Amt$
$
$
If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both. Our signatures certify this information is correct.
Student Signature Date / Parent Signature DateNOTICE: This form must be submitted to our office within 14 days of this request. If the required documentation is not received, we cannot continue processing your application for financial aid. Processing will not resume until/unless the necessary information/documents are provided. If the 14-day time period extends to or beyond registration day, you must either pay the institutional costs from personal funds, or request a payment plan from the Student Accounts Office.
IF YOU WERE REQUIRED TO COMPLETE SECTION C, PLEASE SIGN, DATE AND SUBMIT THIS SHEET ONLY
YOU MUST HAVE ACCESS TO A PRINTER IN ORDER TO PRINT AND SUBMIT THIS FORM
Your 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. THIS DOCUMENT IS A FORM - PLEASE TYPE YOUR INFORMATION IN THE GRAY AREAS PROVIDED. USE THE “TAB” KEY ON YOUR KEYBOARD TO MOVE TO THE SPACES PROVIDED – DO NOT USE THE “ENTER” KEY.
SECTION D:
please read the instructions for the Statement of educational purpose below before completinG ~
First Name: / Last Name: / SS#: X X X – X X -FULL Mailing Address:
Phone: / Email:
One of the persons listed in the Household Information above received SNAP benefits, formerly known as Food Stamps in 2012 or 2013?
Yes (REQUIRED – you must submit proof of your receipt of SNAP – letter or printout from agency listing year(s) received or other verifiable proof) No
In 2013 child support was paid by someone in the Household? Yes (Complete Child Support section below) No
Name of Person who PAID Child Support / Name of Person who RECEIVED Child Support / Name of Child the Support Was For / Total Amt$
$
I previously attended WDT OR I am a NEW student - the following will be provided to WDT’s Admissions Office: (Please check (X) one):
A copy of my final official high school transcript that shows the date when my diploma was awarded.
A copy of my General Educational Development (GED) transcript that includes my GED scores.
STOP –You must appear in person to complete this section and present your government issued ID (such as a driver’s license, military ID, passport) and this form to a WDT Financial Aid staff member, who will validate the statement below at the time of submission by maintaining a copy of your photo ID and by providing a signature and date.
Statement of Educational Purpose
I certify that I ______am the individual signing this Statement of Educational Purpose and that the federal
Print Student’s Name
student financial assistance I may receive will be used only for educational purposes and to pay the cost of attending WDT for 2014–2015.
______
Student’s Signature Date WDT Financial Aid Staff’s Signature Date
If you cannot appear in person at the WDT Financial Aid Office, you must provide a copy of your government issued photo ID and have this notarized by a public notary.
Notary’s Certificate of Knowledge – Please notarize student’s signature above.
State of ______City/County of ______on ______(date) before
me, ______personally appeared, ______and provided to me on basis of
Notary’s Name Printed Name of Signer
satisfactory evidence of identification ______to be the above named person who signed the foregoing instrument.
Type of Government Issued Photo ID Provided
WITNESS my hand and official seal (SEAL)
______
Notary’s Signature Date Commission Expires
If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both. Our signatures certify this information is correct.
Student Signature Date / Parent Signature DateNOTICE: This form must be submitted to our office within 14 days of this request. If the required documentation is not received, we cannot continue processing your application for financial aid. Processing will not resume until/unless the necessary information/documents are provided. If the 14-day time period extends to or beyond registration day, you must either pay the institutional costs from personal funds, or request a payment plan from the Student Accounts Office.
IF YOU WERE REQUIRED TO COMPLETE SECTION D, PLEASE SIGN, DATE AND SUBMIT THIS SHEET ONLY
YOU MUST HAVE ACCESS TO A PRINTER IN ORDER TO PRINT AND SUBMIT THIS FORM
Your 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. THIS DOCUMENT IS A FORM - PLEASE TYPE YOUR INFORMATION IN THE GRAY AREAS PROVIDED. USE THE “TAB” KEY ON YOUR KEYBOARD TO MOVE TO THE SPACES PROVIDED – DO NOT USE THE “ENTER” KEY.
SECTION E (2 PAGES):
please read the instructions for the Statement of educational purpose below before completinG ~
First Name: / Last Name: / SS#: X X X – X X -FULL Mailing Address:
Phone: / Email:
HOUSEHOLD INFORMATION:
List the people in the space provided below that your parents will support between July 1, 2014 and June 30, 2015. Include yourself, your parents (including a step parent), and your parent’s dependent children (if your parents provide more than half their support or if they would be required to give parental information when applying for Federal Student Aid). 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 institution.
Name / Age / Relationship / College Attending (if applicable)SELF / Western Dakota Tech
Source(s) If $0 income, type below “I had no income in 2013” / 2013 Amount
$
$
NOTE: RIGHT CLICK ON THE NUMBER
TO THE LEFT, AND SELECT
UPDATE FIELD TO TOTAL THE COLUMN / $ 0.00
STUDENT:
IF YOU DID NOT file a 2013 federal income tax return,
mark this box, attach your W-2 forms and COMPLETE SOURCES OF INCOME SECTION
OR
IF YOU FILED a 2013 federal income tax return, mark this box.
Source(s) If $0 income, type below “I had no income in 2013” / 2013 Amount$
$
$
NOTE: RIGHT CLICK ON THE NUMBER
TO THE LEFT, AND SELECT
UPDATE FIELD TO TOTAL THE COLUMN / $ 0.00
PARENTS:
If you DID NOT file a 2013 federal income tax return.
Mark this box, attach your W-2 forms and COMPLETE SOURCES OF INCOME SECTION
OR
IF YOU FILED a 2013 federal income tax return, mark this box.
One of the persons listed in the Household Information above received SNAP benefits, formerly known as Food Stamps in 2012 or 2013?
Yes (REQUIRED – you must submit proof of your receipt of SNAP – letter or printout from agency listing year(s) received or other verifiable proof) No
In 2013 child support was paid by someone in the Household? Yes (Complete Child Support section below) No
Name of Person who PAID Child Support / Name of Person who RECEIVED Child Support / Name of Child the Support Was For / Total Amt$
$
PLEASE TURN TO PAGE 2 TO COMPLETE SECTION E
PAGE 2 OF SECTION E
I previously attended WDT OR I am a NEW student - the following will be provided to WDT’s Admissions Office: (Please check (X) one):
A copy of my final official high school transcript that shows the date when my diploma was awarded.
A copy of my General Educational Development (GED) transcript that includes my GED scores.
STOP –You must appear in person to complete this section and present your government issued ID (such as a driver’s license, military ID, passport) and this form to a WDT Financial Aid staff member, who will validate the statement below at the time of submission by maintaining a copy of your photo ID and by providing a signature and date.