Financial Aid Verification Worksheet Template


Financial Aid
4227 Fifth Avenue
Pittsburgh, PA 15260
Phone: 412-624-7488
Fax: 412-648-8815
2016 – 2017
What is Verification?
The U.S. Department of Education (ED) randomly selects students at each institution for schools to verify information on their
FAFSA. Your FAFSA has been selected for us to collect and verify information related to your FAFSA answers.
• Complete all sections of this worksheet. Write “0” for any income not received and “N/A” for sections that do not apply.
• Collect requested 2015 financial documents, for you and your spouse (if married) or for your parent(s) (if dependent).
• Submit this completed form, along with the required financial documents to the address, fax, or email at the top of this page.
Documents must be submitted within 14 days of the initial request to avoid a significant delay in receiving your financial aid. We will
notify you if additional information is needed. This process takes several weeks to complete, so prompt attention to this request is
essential for the timely processing of your financial aid.
Student Information: Please print neatly so we are able to match your information to your file.
Student’s Full Legal Name:_________________________________________________
Student ID Number:____________________
Street Address:___________________________________________________________________________________________________
City, State, Zip:___________________________________________________________________________________________________
Student’s Email Address:___________________________________________
Student’s Cell Number:________________________
Household: List yourself first regardless of where you live. List others as they apply.
DEPENDENT STUDENTS should also list:
INDEPENDENT STUDENTS should also list:
• Parents (biological or adoptive), if they are living
• Your spouse (if married, and not separated)
together, regardless of marital status or gender. This
• Your children or any other people, if they now live with
may include a step-parent if your parent is remarried—
you, if you* will provide more than half of their support,
even if you do not live with your parents.
and you will continue to provide more than half of their
• Other dependent children of your parents or any other
support from July 1, 2016–June 30, 2017.
people, if your parent(s) will provide more than half
of their support from July 1, 2016 - June 30, 2017, or
they would be required to provide parental information
* This includes support provided by your spouse if you
when applying for Federal Student Aid.
are currently married and not separated.
Check here and attach a separate sheet with student name if more space is needed for additional household members.
Full Name
Relation to Student
College/University attending 2016–17
(degree seeking, attending at least half-time)
University of Pittsburgh (
) Campus
SNAP Benefits
Did you or any people in the above household receive benefits from the Supplemental Nutrition Assistance
Program or SNAP (formerly known as the Food Stamps Program) at any time in 2014 or 2015?
¨ No
Child Support Paid: Complete this section if you, your spouse or one of your parents PAID child support in 2015. (Attach a
separate sheet if additional space is needed.)
Name of Person in the Household
Name of Person to Whom Child Support
Name of Child for Whom Support
Age of
Amount of Child
Who PAID Child Support
was PAID (not in the Household)
Was Paid (not in the household)
Support Paid in 2015


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