Verification Of Additional Household Resources Page 2
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DEP
Name:_________________________________________________________________
SPIRE ID:___________________________
If your total annual household income falls below the following 2014 Federal Poverty Guidelines, please provide a detailed
explanation of how the family was supported during the 2014 year in the box below.
# of People
1
2
3
4
5
6
7
8
Each additional
100% FPL
$11,676
$15,732
$19,800
$23,856
$27,912
$31,980
$36,036
$40,092
+$4,068
Explan how the family met all fi nancial obligations in 2014 (rent/mortgage, food, heat, health insurance,taxes,etc.):
PART III: CERTIFICATION
Any fi nancial aid awarded prior to verifi cation is tentative. Financial Aid Services has the right, after reviewing your verifi cation information, to
change or cancel your award. Changes in funding, administrative/technical errors, changes in application information, enrollment status or
reclassifi cation in residency will affect your fi nancial aid award and may result in a revised fi nancial aid award.
By my signature, I certify that all information submitted with and written on this application is complete, accurate, and corrections may be
made based on data provided, and that if I purposely give false or misleading information on this worksheet, I may be fi ned, sentenced to
prison, or both. I also certify that any federal or state fi nancial aid funds I may receive will only be used to pay for educational expenses
related to my attendance at the University of Massachusetts Amherst for 2015-2016.
____________________________________________________________________________
Please be aware Financial Aid Services is obligated
Student Signature
Date
to report fi nancial aid applicants that purposely
misreported information or altered documentation
to obtain federal funds to the Offi ce of Inpector
General for investigation and prosecution.
____________________________________________________________________________
Parent Signature
Date
Document must be signed with a real signature. Digital signatures are not accepted.
Fax completed, signed form to: 413-545-1700
or email completed, signed form to: fadocs@fi naid.umass.edu
(Attachments must be a standard image fi le, or in one of the following fi le formats: .doc, .docx, .pdf)
*FDRESE*
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