2014-2015 Child Support/food Stamp Verification Worksheet

15FAV4

myUH ID __________

2014-2015 Child Support/Food Stamp Verification Worksheet

Instructions:

Your

application

was

selected

for

review

in

a

process

1. Complete and sign worksheet. Please make

called “Verification.” In this process, we will be comparing information from

sure no fields are left blank.

your FAFSA with copies of your documents. The law says we have the right

2. Submit this form and any other documents

to ask you for this information before awarding Federal aid. If there are

initiated in your myUH To-Do List to:

differences between your application information and your documents, we

The Office of Scholarships and Financial Aid

may need to make corrections electronically through the federal processor.

In Person: Welcome Center

Online:

**This form should ONLY be submitted if your FAFSA

Via your myUH account To-Do List

application was selected for the verification process**

Visit

uh.edu/sfaupload

for more information on how to upload

your verification forms online.

A. Student Information

_____________________________________________________________

________________________

Last Name

First Name

MI

myUH ID

B. Child Support

(check appropriate statement)

I (or my spouse) paid child support to another household in 2013.

My parent(s) paid child support to another household in 2013.

No one paid child support to another household in 2013.

If child support was paid, please complete each section below:

Name of Person Who Paid

Relationship to Student

Name of Person to

Name of Child for Whom

Amount of Child

Child Support

Whom Child Support was

Child Support was Paid

Support Paid for 2013

Paid

$

$

$

$

$

If more space is needed, provide a separate page that includes the student’s name and ID number at the top.

C. Food Stamps or Supplemental Nutrition Assistance Program (SNAP)

(check appropriate statement)

I (or my spouse) received Food Stamps or SNAP during 2012 or 2013.

My parent(s) received Food Stamps or SNAP during 2012 or 2013.

No one received Food Stamps or SNAP during 2012 or 2013.

D. Sign this Worksheet

Each person signing this form certifies that all the information reported on it is complete and correct. If you were required to provide parent

information, at least one parent must also sign this form.

_________________________________

_____________

WARNING: If you purposely give false or

misleading information on this worksheet, you

Student

Date

may be fined, be sentenced to jail, or both.

_________________________________

_____________

Parent (or Spouse, if applicable)

Date

State law requires that you be informed of the following: (1) with few exceptions, you are entitled on request to be informed about the information the University collects about you by use of this form; (2) under sections

552.021 and 552.023 of the Government Code, you are entitled to receive and review the information; and (3) under section 559.004 of the Government Code, you are entitled to have the University correct information

about you that is incorrect.

University of Houston - Office of Scholarships and Financial Aid · 5000 Gulf Freeway, ERP2 Room 224, Houston, TX 77204-2010

Phone (713)743-1010 · Fax (713)743-9098 · Welcome Center M-T 8am-7pm W-F 8am-5pm ·