2014-15 Dependent Verification Worksheet Template


2014-15 Dependent Verification Worksheet
University of Wisconsin-Stout
Financial Aid Office
Your application was selected by the US Department of Education for a process called verification. We must compare the
information on your FAFSA with the information you provide on this form. If there are differences between your FAFSA and the
documents you submit, we will make corrections on your FAFSA or contact you for further clarification.
A. Student Information
Last Name ____________________________________________ First Name _________________________________ M.I. ______
UW-Stout Campus ID ___________________________________ Phone Number _________________________________________
B. Family Information
List all the people in your parent(s) household. Include:
 Student (yourself)
 Parent who filed the FAFSA and spouse (parent or stepparent), if married.
 Other children if they will receive more than half of their support from your parents between July 1, 2014
and June 30, 2015.
 Other people if they now live with your parents and receive more than half of their support from your parents, and
they will continue to receive more than half of their support from your parents between July 1, 2014
and June 30, 2015.
If a person will attend college half-time or more during 2014-15 (in a degree, diploma, or certificate program), write in the name of the
college they will be attending. If more space is needed, attach an additional sheet.
Full Name
Relationship to you
Name of College (if attending)
University of Wisconsin-Stout
C. Child Support Paid by Student or Parent (Report 2013 Calendar Year amounts)
Report the child support you or your parent paid because of divorce or separation or as a result of a legal requirement. Do not include support for
children in your (or your parents’) household. List children for whom child support was paid in 2013.
Name of person who paid
Name of person to whom child
Name of child for whom support
Amount of child support paid
child support
support was paid
was paid
in 2013
D. SNAP Benefits Received
Check the appropriate box above:
Did one or more of the persons listed in Section B of this worksheet receive benefits from the Supplemental Nutrition Assistance
Program or SNAP (formerly known as food stamps or FoodShare) any time during the 2012 or 2013 calendar year?
DVF Feb 2014


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