Form Indv1 -Independent Verification Worksheet Page 2
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1
2Part 3. Family Information:
List the persons in your household in the chart below. Include the following:
1.
Yourself
2.
Your spouse if you are married (includes same sex spouse)
3.
Your children if:
a)
You will provide more than half of the children’s’ support from July 1, 2016 to June 30, 2017
4.
Other people if they now live with you and you provide more than half of their support and will continue to
provide more than half their support from July 1, 2016 to June 30, 2017.
Also, identify the name of the college for any family member who will be attending college between July 1, 2016 and June 30, 2017 and
will be enrolled at least half‐time (6 or more credits) in a degree or certificate program. If you need more space add a separate page.
Name of College in 2016‐2017** Enrolled at least ½ time
First and Last Name*
Age Relationship
Example: Martha Jones
19
Daughter
San Juan College
yes
1. (Student):
SELF
2.
3.
4.
5.
6.
*Proof of financial support may be requested.
**Proof of enrollment in 2016‐2017 may be requested.
Part 4. Additional Information
A. SNAP (Food Stamps) received in 2014 and/or 2015
1.
Did you and / or your spouse receive SNAP or Food Stamps in 2014 or 2015?
YES _________ If “yes” you MUST attach a copy of the benefit letter or other proof of receiving this benefit.
NO _________
B. Child Support Paid in 2015
1.
Did you and / or your spouse PAY child support in 2015? YES _______ if “yes” you MUST answer questions 2 through 5 below.
NO _______
2. Write the TOTAL amount actually paid in all of 2015: $ _______________________
3. Name of person who paid child support in 2015? _________________________________________
4. Name the person to whom child support was paid: _________________________________________
5. List the children for whom the child support is intended: _____________________________________
_____________________________________
_____________________________________
*If the figure differs from what was reported on the FAFSA further documentation (cancelled checks, legal documents, etc.) may be requested.
Please return this form and all required attachments within two weeks.
Your financial aid WILL NOT be finalized until all verification paperwork is complete.
By signing this worksheet, I (we) certify that all the information reported on this worksheet is complete and accurate. Warning:
If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
______________________________ ___________
Student Signature
Date
Ph. 505-566-3323 Fax: 505-566-3593 E-mail:
financialaid@sanjuancollege.edu
Address: San Juan College, Financial Aid Office, 4601 College Blvd, Farmington, NM 87402
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