Verification Worksheet Dependent Student Template - 2015-2016 (Page 4 of 4) in pdf

Verification Worksheet Dependent Student Template - 2015-2016 Page 4

NAME __________________________________________________________________

Last

First

Student ID Number

H. Child Support Received

Complete this section if child support was received in 2014 for any children listed in your household.

Name of Person who

Name of Child for whom

Amount of Child Support

Received Child Support

Support was Paid

Received in 2014

Example: Joe Jones

Jim Jones

$5,000

Do Not Include: Foster care payments, adoption payments or any amount that was court ordered but not actually paid.

I. Certification and Signatures

Each person signing this worksheet certifies that all of the information reported on it is complete and correct. WARNING: If you purposely give false

or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.

The student and one parent must sign and date.

Student’s Signature _____________________________________________________________ Date ____________________________

Parent’s Signature ______________________________________________________________ Date ____________________________

Do not mail this worksheet to the U.S. Department of Education. Submit this worksheet to the

financial aid administrator at your school. You should make a copy of this worksheet for your records.

Office of Financial Aid

Grace E. Harris Hall Student Service Center

1015 Floyd Ave., 1st Floor

P.O. Box 843026

Richmond, VA 23284-2520

•

(804) 828-6669

Fax (804) 827-0060

•

VCU is an EEO/AA institution. ENR1314-121

Verification Worksheet Dependent Student Template - 2015-2016 Page 4