Verification Independent - Worksheet V4 - 2016-2017

2016-­‐2017   V erification    

Independent   -­‐   W orksheet   V 4  

The   F AFSA   a pplication   w as   s elected   b y   t he   D epartment   o f   E ducation   f or   a   p rocess   c alled   “ verification.”   I n   t his   p rocess,   w e   a re   r equired   b y   l aw   t o   c ompare  

the   i nformation   r eported   o n   t he   F AFSA   w ith   t he   i nformation   p rovided   o n   t his   f orm.   T he   f inancial   a id   c annot   b e   f inalized   u ntil   v erification   h as   b een  

completed,   p lease   p rovide   t he   r equired   d ocuments   a s   s oon   a s   p ossible.    

To   c omplete   t he   v erification   p rocess,   p lease   f ollow   t hese   s teps:    

1. Please   w rite   c learly,   c omplete   a ll   s ections,   a nd   s ign   t he   w orksheet.    

2. Bring,   m ail,   e mail   o r   f ax   t he   c ompleted   f orm,   t ax   t ranscripts,   a nd   a ny   o ther   d ocuments   t o   o ur   o ffice.    

3. We   w ill   c ompare   t he   i nformation   o n   t hese   d ocuments   a nd   r equest   a dditional   i nformation   o r   m ake   c orrections   i f   n ecessary.  

STUDENT   I NFORMATION

 

Name____________________________                   B irth   D ate__________SSN   o r   I D   N umber       _ ____________  

HomeAddress_________________________________________________________________________            

Daytime   P hone_____________   A lternate   o r   C ell   P hone   #   _ ____   _ ___________       E -­‐Mail   _ ____________    

 

 

RECEIPT   O F   S NAP   B ENEFITS

 

 

The   s tudent   c ertifies   t hat   _ _____________________________,   a   m ember   o f   t he   s tudent’s   h ousehold,   r eceived   b enefits   f rom   t he  

Supplemental   N utrition   A ssistance   P rogram   ( SNAP)   s ometime   d uring   2 014   o r   2 015.   S NAP   m ay   b e   k nown   b y   a nother   n ame   i n   s ome   s tates.   F or  

assistance   i n   d etermining   t he   n ame   u sed   i n   t he   s tate,   p lease   c all   1 -­‐800-­‐433-­‐3243.  

Note:     I f   w e   h ave   r eason   t o   b elieve   t hat   t he   i nformation   r egarding   r eceipt   o f   S NAP   b enefits   s   i naccurate,   w e   m ay   r equire   d ocumentation  

from   t he   a gency   t hat   i ssued   t he   S NAP   b enefit   i n   2 014   o r   2 015.  

 

CHILD   S UPPORT   P AID   2 015

 

Complete   t his   s ection   i f   t he   s tudent   a nd/or   s pouse   p aid   c hild   s upport   i n   2 015.  

Name   o f   P erson   W ho   P AID   C hild   S upport     _ _______________________________  

Name   o f   P erson   t o   W hom   C hild   S upport   w as   P AID   _ ________________________  

Name   a nd   A ge   o f   C hild   f or   W hom   S upport   w as   P AID   _ _______________________  

Annual   A mount   o f   C hild   S upport   P AID   i n   2 015   _ ____________________________  

Note:     I f   w e   h ave   r eason   t o   b elieve   t hat   t he   i nformation   r egarding   c hild   s upport   p aid   i s   i naccurate,   w e   m ay   r equire   a dditional  

documentation,   s uch   a s:     s igned   s tatement   f rom   t he   i ndividual   r eceiving   t he   c hild   s upport   c ertifying   t he   a mount   o f   c hild   s upport   r eceived;   o r  

copies   o f   t he   c hild   s upport   p ayments   c hecks,   m oney   o rder   r eceipts,   o r   s imilar   r ecords   o f   e lectronic   p ayment   h aving   b een   m ade.  

 

CERTITICATIONS   A ND   S IGNATURE

 

The   p erson   s igning   b elow   c ertifies   t hat   a ll   t he   i nformation   r eported   i s   c omplete   a nd   c orrect.   I f   y ou   p urposely   g ive   f alse   o r   m isleading  

information   o n   t his   w orksheet,   y ou   m ay   b e   f ined,   b e   s entenced   t o   j ail,   o r   b oth.   T his   a pplication   r equires   a   s tudent   s ignature.   P lease   n ote:   t he  

signature   c annot   b e   t yped.  

 

Student   S ignature   _ ______________________________________________________________                     D ate   _ ___________________________  

 

 

Please   r eturn   t his   f orm   t o:   L oyola   U niversity   -­‐ Office   o f   S cholarships   a nd   F inancial   A id       6 363   S t.   C harles   A ve   N ew   O rleans   L A   7 0115  

Fax   ( 504)   8 65-­‐3233  

w

ww.loyno.edu/financialaid  

 

Remember:   L oyola’s   U niversity   p riority   d eadline   t o   f ile   t he   f ederal   F AFSA   f orm   i s   M arch   1 ,   2 016   f or   i ncoming   f irst-­‐year   s tudents   a nd   A pril  

1,   2 016   f or   r eturning   s tudents.   W hile   i t   i s   o ur   g oal   t o   m ake   i t   f inancially   f easible   f or   a ny   s tudent   t o   a ttend   L oyola,   a ny   s tudent   w ho  

submits   h is   o r   h er   F AFSA   a fter   o ur   p riority   d eadlines   w ill   b e   a warded   o n   a   “ funds   a s   a vailable”   b asis.   Y ou   m ay   e stimate   i n   o rder   t o   m eet  

deadlines.  

Failure   t o   l ist   L oyola   U niversity   N ew   O rleans   o n   y our   f ederal   F AFSA   f orm   m ay   r esult   i n   a   d elayed   a ward.   T he   L oyola   U niversity   N ew  

Orleans     T itle   I V   C ode   i s   0 02016.