2013-2014 SNAP Benefits Verification for 2011 and 2012 - Terra ...

2013-2014 Supplemental Nutrition Assistance
Program Benefit (SNAP) Certification Form
The U.S. Department of Education has selected your FAFSA for review in a process called Verification. In this process, we
will be collecting information and supporting documents to verify the information from your FAFSA. You indicated that
a member of your household received Supplemental Nutrition Assistance Program Benefits (formerly known as Food
Stamps) in 2011 and/or 2012. Federal law indicates that the Office of Financial Aid has the right to ask for this
documentation before awarding federal and state aid. Your financial aid at Terra State Community College cannot be
processed until this form is completed and returned to us with all requested supporting documentation. You will receive an
updated Student Aid Report (SAR) from the U.S. Department of Education which shows the corrections made. If these
corrections change your eligibility for aid, you will also receive an updated award notice.
What you must do now:
1. Request a copy of SNAP eligibility letter or contact the Ohio Department of Job and Family Services and request
an “Eligibility printout” for SNAP Benefits for 2011 and/or 2012. Please make sure that you include the Social
Security Number or Student ID number for the Terra State Student on the SNAP printout.
2. Complete this form
3. Submit this signed form and the Statement of SNAP benefits received to:
Office of Financial Aid
Terra State Community College
2830 Napoleon Road
Fremont, OH 43420
Fax to (419) 559-2352
This form must be signed by student and spouse(if applicable).
If you are a dependent student this form must also be signed by a parent/guardian.
4. Monitor your student portal to see if additional information has been requested.
Note:
In order to ensure that your verification is complete by the first disbursement, all requested documentation should be
submitted by the dates list below. Information received after these date may result in a delay in processing your aid.
Fall 2013 Spring 2014 Summer 2014
6/15/2013 12/6/2013 4/18/2014
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2013-2014 Supplemental Nutrition Assistance
Program Benefit (SNAP) Certification Form
Student Information
Student’s Full Name:______________ _________________ _____________ SS#_______________
(Please Print) First M.I. Last (or Student ID)
______________________________________
Date of birth
__________________________________
Student Phone number(s) (include area code)
SNAP Benefits Received
_ I, myself, or a member of my household DID NOT receive Supplemental Nutrition Assistance Program Benefits (formerly
known as Food Stamps) in 2011 and/or 2012
OR
_I, myself, or someone in my household DID receive Supplemental Nutrition Assistance Program Benefits (formerly known as
Food Stamps) in 2011 and/or 2012. Please attach a copy of the SNAP eligibility letter for your household.
Sign this Form
This form must be signed by student. By signing this form, I certify that all the information reported on this form is complete
and correct.
______________________________________
Student’s signature
______________________________________
Spouse’s signature or Parent/Guardian
______________________________________
Date
______________________________________
Date
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