Verification Worksheet Federal Student Aid Programs - Northwestern State University - 2017-2018 Page 2
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2Dependent-V1/V5
E. WAGE INFORMATION - PLEASE COMPLETE THIS SECTION ONLY IF YOU ARE NOT REQUIRED TO FILE A 2015 IRS 1040
*If you and/or parent(s) worked in 2015 please list your wage information below. Provide all 2015 W-2 forms.
*Be sure to enter zeroes if no funds were received and/or indicate did not work in the appropriate blanks.
*In all cases you must also provide a verification of non-filing stated from the IRS dated on or after October 1, 2016.
The verification of non-filing can be requested by submitting a 4506-T form (option 7) to the IRS.
*Failure to complete this section will delay the processing of your verification.
Employer’s Name
Income Earned From
Income Earned From
Income Earned From
Work for Student
Work for Mother
Work for Father
Suzy’s Auto Body Shop (example)
$2000
F. CHILD SUPPORT PAID
Did you or your parents Pay child support during 2015? CHECK ONE BELOW
NO
YES, please complete the information in the box below
Note: If NSU believes that the information regarding the Child Support Payment information is inaccurate, we may require additional
documentation.
Name of Person Who Paid
Name of Person to whom
Name of Child for Whom Child
Age of
Annual amount of child
Child Support
Child Support Was Paid
Support Was Paid
child
support paid in 2015
G. SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)
Did you or any person in your household as listed in Section B of this worksheet received Supplemental Nutrition Assistance Program benefits in
2014 or 2015?
No
Yes
Note: If NSU believes that the information regarding the receipt of SNAP (Food Stamp) benefits is inaccurate, we may require documentation
from the agency that issued the SNAP benefits in 2014 or 2015.
H. CERTIFICATION AND SIGNATURE
Each person signing below certifies that all of the information reported is complete and correct. The student whose information was
reported on the FAFSA must sign and date. Warning: If you purposely give false or misleading information, you may be fined, be sentenced
to jail, or both.
Student’s Signature
Date
Parent’s Signature
Date
Return by fax, email or mail to:
Northwestern State University
Office of Student Financial Aid
212 Student Services Center
Natchitoches, La 71497
318-357-5961 Phone 318-357-5488 Fax
nsufinaid@nsula.edu
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