2014-15 Dependent Verification Worksheet Template printable pdf download

2014-15 Dependent Verification Worksheet

Dependent

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

Age

Relationship to you

Name of College (if attending)

Self

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

Yes

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

2014-15 Dependent Verification Worksheet Template