Independent Student Verification Worksheet (Page 4 of 4) in pdf

Independent Student Verification Worksheet Page 4

Georgia Tech ID

Office of Scholarships and Financial Aid

Step III: Household Size

List the names of the people in your household. Include:

•

Yourself and your Spouse (if you are married)

•

Your children (if applicable) and other people if they now live with you and you will continue to

provide more than 50% of their support between July 1, 2016 and June 30, 2017

List their relationship to you, their age, and name of the college/university (if applicable) for each person.

Support includes, but is not limited to clothes, food, shelter, etc.

Post-Secondary

Name

Age

Relationship

College/University

Self

Georgia Institute of Technology

*Note: If any household member, such as a grandparent, receives benefits in their own name(s), please do not include

those members in the household size unless more than half of their support is provided by the student.

Step IV: Supplemental Nutrition Assistance Program (SNAP)

In 2014 or 2015, did you or anyone in your household receive Federal Supplemental Nutrition Assistance

Program (SNAP, previously known as food stamps)? ☐Yes ☐No

If yes, please list Name of Recipient(s) ________________________________

I certify that all information provided is accurate and true to the best of my knowledge.

Student’s Signature

Date

Spouse’s Signature

Date

225 North Ave. Atlanta, GA 30332-0460

Phone: 404.894.4160 Fax: 404.894.7412

**Faxes are received by a secure server**

Via Email: finaid@gatech.edu

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Independent Student Verification Worksheet Page 4