2015-16 Verification Worksheet (V-1 Standard) Page 2
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42015-16 Verification Worksheet (V-1 Standard)
C. Family Information
Independent Student
Dependent Student
Independent Student household include:
Dependent Student household include:
- The student
- The student
- The student’s spouse, if married and dependent
- The student’s parent(s), including stepparent, that you
last lived with even if you don’t live with them now.
children, even if they do not live with you, and
- Other people if they now live in your parent’s household
- Other people if they now live with you and you
provide more than half of their support from July
and provide more than half of their support from July 1,
1, 2015 to June 30, 2016
2015 to June 30, 2016 (ex: siblings, etc.)
\
Include the names and information for the persons in your household, according to your dependency status.
Note: If more space is needed, attach a separate page with the requested information below. Include your name and ID number.
Attending a college or
university at least half
Age
Relationship
College
Time
Full Name
(Please Circle)
Yes
No
Self
UDC
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
D. Supplemental Nutritional Assistance Program (SNAP/ Food Stamps) (Please Check One)
Yes __ No __ One of the persons listed in Section C of this worksheet received SNAP benefits (formerly known as food
stamps) during the 2013 or 2014 calendar years. If asked by the student’s school, I will provide documentation of
the receipt of SNAP benefits during 2013 and/or 2014.
E. Child Support Paid (Please Check One)
Yes __ No _
Either I, or my spouse (if married), or my parent(s) (if dependent) who is listed in Section C of this worksheet, paid
child support in 2014. If yes, please enter the requested information below. Also, if more spaces are needed please
attach a sheet with the additional information to this worksheet.
Name of Student/Spouse or
Name of Person to Whom
Name of Child for Whom
Age of Child
Amount of Child
Parent/ Step Parent Whom
Child Support was Paid
Support Was Paid
for Whom
Support Paid in
Paid Child Support
Support Was
2014
Paid
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16-V1
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