Household Resources Verification Form
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2Household Resources Verification Form
2015-2016
Student’s Name: ____________________________________ Student ID: ________________________
The Department of Education has selected your FAFSA for verification. This process requires us to collect the
following information. You must complete both sides (two pages) of this form.
SECTION 1 - Household Size
If you reported parent information on the FAFSA,
If you reported only student information
include:
on the FAFSA, include:
Yourself and the parent(s) you live with or most
Yourself and your spouse, if you have
recently lived with (including a stepparent)
one
Your parent(s)’ other children if:
Your children, if you will provide more
your parent(s) will provide more than
than half of their support from July 1,
half of their support from July 1, 2015 through
2015 through June 30, 2016
June 30, 2016, or
Your other dependents, if they live with
the children would be required to provide the
you and you will provide more than half
same parent information when completing the
of their support from July 1, 2015
FAFSA
through June 30, 2016.
Your parent(s)’ other dependents if they live with them
and your parent(s)’ will provide more than half of their
support from July 1, 2015 through June 30, 2016.
List the name, age and relationship of all household members who meet the above definition. Write the
name of the College if that person will be attending at least half-time between July 1, 2015 and June 30, 2016
while enrolled in a degree or certificate program. Attach a note with this information, if more space is needed.
Please Note: If you reported that you paid child support in 2014 on your FAFSA, do not include the child you
paid support for on this form.
Full Name
Age
Relationship to You
College
Self
QCC
SECTION 2 - Receipt of Benefits
Check all that apply. We will assume “No” when blank. In 2014 or 2015, did anyone in your household
receive:
Supplemental Security Income (SSI)
Temporary Assistance for Needy Families (TANF)
Food Stamps/Supplemental Nutrition
Special Supplemental Nutrition Program for
Assistance Program (SNAP) – If requested by the
Women, Infants and Children (WIC)
College, I can provide documentation of the receipt of
Free or Reduced Price School Lunch
these benefits.
Financial Aid Office Quinsigamond Community College
670 West Boylston St. Worcester, MA 01606
Office hours: Monday-Thursday 8-7, Fridays 8-5
Phone: (508) 854-4261 Fax: (508) 854-7432
financialaid@qcc.mass.edu
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