Verification Worksheet Template 2015-16 (Page 2 of 2) in pdf

Verification Worksheet Template 2015-16 Page 2

Student Name_________________________________________

RMU ID #______________________

Student

2014 Additional Income and Financial Information

Parent

Payments to tax-deferred pension and savings plans (paid directly or withheld from

earnings), including, but not limited to, amounts reported on the W-2 Form in Boxes

12a through 12d, codes D, E, F, G, H, and S.

Child support RECEIVED annually for all children.

(Don’t include foster care or adoption payments)

Other money received, or paid on your behalf (e.g., bills), not reported elsewhere on

this form. Parental support should not be included.

Source: _________________________________

Did anyone in your household receive food stamps (SNAP) in 2013 or 2014? ❑Yes ❑ No

If asked by the Financial Aid Office, please be prepared to provide supporting documentation.

In 2014 was child support PAID by any member listed in your household? ❑Yes ❑ No

If yes, complete the following information (attach a separate sheet if necessary):

Amount

Name of person who made

Name of person who

Name of Child

Age

per Child

payment

received payment

D. Non-Tax Filer Information

If you or your parent(s) (if dependent) did NOT file a 2014 Federal tax return, please report any earnings

received from working (Attach a copy of all applicable W-2 forms):

Amount Earned

Employer

Student

Parent

E. Certification

By signing below, I (we) certify that all the information reported to qualify for Federal student aid is complete

and accurate. If the student is dependent, both parent and student MUST sign.

Student

Date

Parent

Date

RETURN TO: Financial Aid Office, 6001 University Blvd, Moon Township, PA 15108

f:412.397-6499/finaid@rmu.edu

Verification Worksheet Template 2015-16 Page 2