Verification Worksheet - Wenatchee Valley College Page 3
Download a blank fillable Verification Worksheet - Wenatchee Valley College in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Verification Worksheet - Wenatchee Valley College with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
32013-2014
I
NDEPENDENT
Verification Worksheet
Federal Student Aid Programs
D.
Clear Page
UNTAXED INCOME/BENEFITS
page 3 of 3
Answer each item in each question. Do not leave any item blank. If you have questions, please contact our office for assistance.
1. STUDENT UNTAXED INCOME:
You must answer each of the following about YOURSELF (and spouse if married).
If they do not apply to you, enter zeros. Do not include benefit types listed in question 2.
Yearly
Yearly
Source of Untaxed Income
Source of Untaxed Income
Amount
Amount
a. Child support received in 2012
b. Worker’s Compensation
$
$
d. Any other untaxed income (NOT included on tax
c. Living allowance paid to clergy or military
(military: include only BAS, do not include BAH) $
$
return): __________________________ [list source]
2. STUDENT UNTAXED BENEFITS/ASSISTANCE:
Answer all items a - k for YOURSELF and all household members
listed on page 1. Note that items “a-e” refer to years 2011 - 2013, items “f-k” refer to years 2012-2013 only. THESE
BENEFITS ARE NOT COUNTED AS INCOME & RECEIVING THEM DOES NOT HURT YOUR ELIGIBILITY FOR AID.
Benefit Type A-E
2011
2012
2013
Benefit Type F-J
2012
2013
a. Food Stamps/SNAP
No
Yes
Yes
Yes
f. Untaxed Social Security
No
Yes
Yes
b. Welfare/TANF
No
Yes
Yes
Yes
g. Medical Assistance
No
Yes
Yes
c. Supplemental Security Inc. (SSI)
No
Yes
Yes
Yes
h. Subsidized Housing
No
Yes
Yes
d. Free or Reduced Lunch
No
Yes
Yes
Yes
i. Child Care Assistance
No
Yes
Yes
e. WIC
No
Yes
Yes
Yes
j. Energy Assistance Program
No
Yes
Yes
k. Other non-cash assistance received in 2012 and/or 2013?
2012 (source): _________________________________
No
Yes - check year & list source of assistance
2013 (source): _________________________________
E.
INCOME EXCLUSIONS
1. STUDENT INCOME EXCLUSIONS:
The 2013-2014 FAFSA refers to “Additional Financial Information” for 2012. The
financial aid office must verify the dollar amounts from the 2012 calendar year. You must answer each of the
following. If they do not apply to you (and/or spouse if married), enter zeros, or check “NO”.
Yearly Amount Exclusion type (if you have questions, contact our office)
Taxable earnings from Federal or State Work-study. (Attach W-2 of work-study earnings from college. If any
$
college employed you as a work-study student, you would have received a W-2 for your 2012 earnings. )
Student grant and scholarship aid (in excess of the tuition, fees, books, and supplies) that was reported to the
$
If none reported on tax return, put “0”.
IRS as part of adjusted gross income (AGI) on your 2012 tax return.
Combat Pay or Special combat pay. List ONLY the taxable portion reported in your AGI on your 2012 tax return.
$
No
Yes* Child Support PAID to others in 2012. Do NOT include support you receive. * If YES, complete worksheet below
Name of Person to whom
Name of Child for whom
Amount of Child
Who paid Child Support
Child Support was paid:
Child Support was paid
Support Paid in 2012
Student
Spouse
$
Student
Spouse
$
Student
Spouse
$
Total $
Sign This Worksheet
WARNING: If you purposely give false or misleading information on
this worksheet, you may be fined, be sentenced to jail, or both.
By signing this worksheet, I (we) certify that all the information
reported on this worksheet is complete and correct.
Return this completed form (with required documents) to:
_________________________________ __________
Wenatchee Valley College
Phone 509-682-6810
Financial Aid Office
Fax 509-682-6811
Student
Date
th
1300 5
Street – Wenatchi Hall
Email: financialaid@wvc.edu
_________________________________ __________
Wenatchee WA 98801
Spouse (optional, not required)
Date
Print Form
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal