Dependent Student Fafsa Verification Worksheet (Page 4 of 4) in pdf

Student’s Name: ______________________________________________

SU ID Number: ____________________________________

SECTION E: PARENT’S OTHER INFORMATION TO BE VERIFIED

Check the box below ONLY IF someone in the student’s parent’s household, as listed in Section B of this form, received benefits from the

Supplemental Nutrition Assistance Program (SNAP, the program formerly known as food stamps) any time during the 2014 or 2015

calendar years.

 One of the persons listed in Section B of this worksheet received SNAP benefits in 2014 or 2015. If asked by Seattle University’s

Student Financial Services Office, I will provide documentation of the receipt of SNAP benefits during 2014 and/or 2015.

Check the box below and complete this section ONLY IF the student’s parent(s) listed in Section B of this worksheet paid child support in

2015.

 One (or both) of the student’s parents listed in Section B of this worksheet paid child support in 2015. The parent has indicated below

the name of the person who paid the child support, the name of the person to whom the child support was paid, the names of the

children for whom child support was paid, and the total annual amount of child support that was paid in 2015 for each child. If asked

by Seattle University’s Student Financial Services Office, I will provide documentation of the payment of child support. If you need

more space, attach a separate page that includes the student’s name and SU ID Number at the top.

Amount of

Name of Person

Name of Child

Child Support

Who Paid Child Support

to Whom Child Support was Paid

for Whom Support Was Paid

Paid in 2015

EXAMPLE: Marty Jones

Chris Smith

Terry Jones

$6,000.00

SECTION F: CERTIFICATION AND SIGNATURES

Each person signing this worksheet certifies that all of the information reported on it is complete and correct.

The student and one parent must sign and date below.

WARNING:

Anyone giving false or misleading information on this worksheet may be fined, sentenced to jail, or both.

________________________________________________________________________

___________________________________

Student’s Signature

Date

________________________________________________________________ _______

___________________________________

Parent’s Signature

Date

Please be sure to make a copy of this worksheet for your records.

Mail, scan and email, or fax the completed, signed worksheet to the SFS Office

using the contact information given at the top of the first page.

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Dependent Student Fafsa Verification Worksheet Page 4