Dependent Student Verification Worksheet - 2015-16 Page 4
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DVER
Name:_________________________________________________________________________
SPIRE ID:_____________________________
PART VI: 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
Student Signature
Date
obligated to report fi nancial aid applicants that
purposely misreported information or altered
documentation to obtain federal funds to the
_________________________________________________________________________
Offi ce of Inspector General for investigation and
Parent Signature
Date
prosecution.
Document must be signed with a real signature. Digital signatures are not accepted.
£
I authorize Financial Aid Services to discuss or resolve any verification issues with the following persons: (please print)
Name _______________________________Relationship______________Email____________________________________Tel.# ____________________
Name _______________________________Relationship______________Email____________________________________Tel.#_____________________
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)
*FDVERE*
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