2013-2014 V1-Standard Dependent Verification Worksheet
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2Form 21:V1
2013-2014 V1-Standard Dependent Verification Worksheet
Your 2013-2014 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that
before awarding Federal Student Aid, we may ask you to confirm the information you and your parents reported on your FAFSA. If there are
differences, your FAFSA information may need to be corrected. You and at least one parent must complete and sign this worksheet, attach
any required documents, and submit the form to a financial aid administrator at your school. Financial aid will be held until this information
has been received and reviewed. This form will be returned if not completely filled out.
_____________________________________________________
_________________________________
Student’s Last Name
First Name
M.I.
Student ID#
_____________________________________________________
________________________________
Student’s Address
Phone Number
A. Dependent Student’s Family Information
List below the people in your parent(s)’ household. Include:
Yourself and your parent(s) (including a stepparent) even if you don’t live with your parent(s).
Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2013, through June
30, 2014, and are not independent for financial aid purposes.
Include other children who would be required to provide parental information if they were completing a FAFSA for 2013–
2014.
Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will
continue to provide more than half of their support through June 30, 2014.
Include the name of the college for any household member, excluding your parent(s), who will be enrolled, at least half time
in a degree, diploma, or certificate program at a postsecondary educational institution any time between July 1, 2013, and
June 30, 2014.
If more space is needed, attach a separate page with the student’s name and student ID# at the top.
Will be Enrolled at
Full Name
Age
Relationship
College
Least Half Time
Missy Jones (example)
18
Sister
Central University
Yes
Self
B. Parent’s Other Information to Be Verified (Circle One)
1.
YES
NO
At least one of the persons listed in section A of this worksheet received Food Assistance (SNAP)
benefits in 2011 or 2012.
2.
YES
NO
A persons listed in section A of this worksheet paid child support in 2012. If you answered YES,
please complete the section below.
Name of Person Who Paid
Name of Person to Whom Child
Name of Child for Whom
Amount of Child
Child Support
Support was Paid
Support Was Paid
Support Paid in
2012
Marty Jones
Chris Smith (example)
Terry Jones
$6,000.00
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