Submission of Documents for Federal Financial Aid Verification When complete, submit this form and any additional, required documentation to the Financial Aid Office. Verification will not be completed until all required documents are submitted for review. Name: Any other names you were using when you filed your FAFSA, such as a maiden name: Student ID Number: Documents in this submission: Verification worksheet SNAP benefit receipt documentation Child support payment documentation Confirmation of high school completion Statement of Identity/Educational Purpose Other documentation required by the school Page 1
2015-2016 Verification Worksheet I Independent Student Tracking Group V4 Your 2015 2016 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that before awarding Federal Student Aid, we may ask you to confirm the information you reported on your FAFSA. To verify that you provided correct information, the financial aid administrator at your school will compare your FAFSA with the information on this worksheet and with any other required documents. If there are differences, your FAFSA information may need to be corrected. You must complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the financial aid administrator at your school. Your school may ask for additional information. If you have questions about verification, contact your financial aid administrator as soon as possible so that your financial aid will not be delayed. A. Independent Student s Information Student s Last Name Student s First Name Student s M.I. Student s SSN Student s Street Address (include apt. no.) Student s Date of Birth City State Zip Code Student s Email Address B. Supplemental Nutrition Assistance Program (SNAP) Information Complete this section if someone in the student s household received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2013 or 2014 calendar years. [ ] One of the persons in the student's household received SNAP benefits in 2013 or 2014. If asked by Northeast, I will provide documentation of the receipt of SNAP benefits during 2013 and/or 2014. People in your household include: Yourself and your spouse if you are married. Your children, if any, if you will provide more than half of their support from July 1, 2015, through June 30, 2016, or if the child would be required to provide your information if they were completing a FAFSA for 2015 2016. Include children who meet either of these standards, even if they do not live with you. 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 of their support through June 30, 2016. C. Independent Student s Child Support Paid Complete this section if you and/or your spouse paid child support in 2014. [ ] Either I or my spouse paid child support in 2014. I have indicated below the name of the person who paid the child support, the name of the person to whom the child support was paid, the names of the children for whom child support was paid, and the total annual amount of child support that was paid Page 2
in 2014 for each child. If asked by Northeast, I will provide documentation of the child support paid during 2014 (court receipts or W2s showing deductions for child support in 2014). If you need more space, attach a separate page that includes your name and student ID number at the top. Name of Person Who Paid Name of Person to Whom Name of Child for Whom Amount of Child Support Child Support Child Support was Paid Support Was Paid Paid in 2014 Joe Jones (example) Jane Doe Jake Jones $6,000 D. High School Completion Status You must submit documentation of high school completion or an equivalent along with this worksheet. Check the box of the document you will attach to this worksheet: [ ] A copy of your high school diploma. [ ] A copy of your final official high school transcript that shows the date when the diploma was awarded. [ ] A state certificate or transcript you received after you passed a State-authorized examination (GED test, HiSET, TASC, or other State-authorized examination) that the State recognizes as the equivalent of a high school diploma. [ ] If you completed secondary education in a foreign country, a copy of the secondary school leaving certificate or other similar document. [ ] An academic transcript that indicates you successfully completed at least a two-year program that is acceptable for full credit toward a bachelor s degree. [ ] If you were homeschooled in a state where state law requires you to obtain a secondary school completion credential for homeschool (other than a high school diploma or its recognized equivalent), a copy of that credential. [ ] If you were homeschooled in a state where state law does not require you to obtain a secondary school completion credential for homeschool (other than a high school diploma or its recognized equivalent), a transcript or the equivalent, signed by your parent or guardian that lists the secondary school courses you completed and includes a statement that you successfully completed a secondary School education in a homeschool setting. Page 3
E. Documentation of Identity/Statement of Educational Purpose Identity and Statement of Educational Purpose (To Be Signed at the Institution) The student must appear in person at Northeast Texas Community College to verify his or her identity by presenting a valid government-issued photo identification (ID), such as, but not limited to, a driver s license, other state-issued ID, or passport. The institution will maintain a copy of the student s photo ID that is annotated by the institution with the date it was received and reviewed and the name of the official at the institution authorized to collect the student s ID. In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose provided below. Identity and Statement of Educational Purpose (To Be Signed in the Presence of a Notary) If the student is unable to appear in person at Northeast Texas Community College to verify his or her identity, the student must provide: (a) A copy of the valid government-issued photo identification (ID) that is acknowledged in the notary statement below or that is presented to a notary, such as, but not limited to, a driver s license, other state-issued ID, or passport; and (b) The original Statement of Educational Purpose, which is provided below, must be notarized. If the notary statement appears on a separate page than the Statement of Educational Purpose, there must be a clear indication that the Statement of Educational Purpose was the document notarized. Statement of Educational Purpose I certify that I am the individual signing (Print Student s Name) this Statement of Educational Purpose and that the Federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending for 2015-2016. (Name of Postsecondary Educational Institution) (Student s Signature) (Date) (Student s ID Number) Page 4
Verificación de Identidad y Declaración de Propósito Educativo (Para ser firmadas en la institución) El estudiante debe comparecer en persona en Northeast Texas Community College para comprobar su identidad mediante la presentación de una identificación con fotografía (ID) válida emitida por el gobierno, como una licencia de conducir, otro tipo de identificación emitida por el estado o pasaporte, entre otros. La institución conservará una copia de la identificación con fotografía del estudiante y anotará en ella la fecha en la que se recibió y revisó, y el nombre del funcionario de la institución autorizado a recolectar las identificaciones de los estudiantes. Además, el estudiante debe firmar, en presencia del funcionario de la institución, la Declaración de Propósito Educativo proporcionada a continuación. Verificación de Identidad y Declaración de Propósito Educativo (Para ser firmadas en la presencia de un notario) Si el estudiante no es capaz de comparecer en persona en Northeast Texas Community College comprobar su identidad, debe proporcionar: (c) Una copia de la de identificación con fotografía (ID) válida emitida por el gobierno, que se reconoce en la declaración del notario que aparece a continuación, o que se presenta ante un notario, como una licencia de conducir, otro tipo de identificación emitida por el estado o pasaporte, entre otros; y (d) La Declaración de Propósito Educativo original proporcionada a continuación debe ser notariada. Si la declaración del notario aparece en una página separada de la Declaración de Propósito Educativo, se debe indicar de manera clara que la Declaración de Propósito Educativo era el documento notariado. Declaración de Propósito Educativo Certifico que yo,, soy el individuo que firma esta [Imprimir Nombre del Estudiante] Declaración de Propósito Educativo y que la ayuda financiera federal estudiantil que yo pueda recibir, sólo será utilizada para fines educativos y para pagar el costo de asistir a para 2015 2016. [Imprimir Nombre de Institución Educativa Postsecundaria] [Firma del Estudiante] [la Fecha] [Número de Identificación del Estudiante] Page 5
Notary s Certificate of Acknowledgement State of City/County of On, before me,, (Date) (Notary s name) personally appeared,, and proved to me (Printed name of signer) on basis of satisfactory evidence of identification (Type of government-issued photo ID provided) to be the above-named person who signed the foregoing instrument. WITNESS my hand and official seal (seal) My commission expires on (Date) (Notary signature) Page 6
G. Certification and Signatures WARNING: If you purposely give false or misleading Information on this Worksheet, you may be fined, be sentenced to jail, or both. Each person signing this worksheet certifies that all of the information reported on it is complete and correct. The student and one parent must sign and date. Student s Signature Date Spouse s Signature Date Do not mail this worksheet to the U.S. Department of Education. Page 7