Dependent Student Verification Form V4 - Delaware Technical ...

2013 - 2014 Dependent Student Verification Worksheet (V4)Your application was selected for review in a process called Verification. You will need to provide certain documents aspart of this process. The law says we have the right to ask you for this information before awarding federal financial aid (34CFR, Part 668). The Campus will correct electronically any differences between your application for financial aid and yourfinancial documents. It is important to complete this process as soon as possible. No financial aid decision will be madeunless all required steps are complete, all required information is accurate and all eligibility requirements are met.For the purposes of this Verification Worksheet, “Parent” includes natural parent, adoptive parent and/or stepparent.“Parent” does not mean grandparent(s), foster parent or legal guardian.Need assistance? Contact the Financial Aid Office at:• Owens Campus: 302-855-1693 email: owens-finaid@dtcc.edu• Stanton Campus: 302-453-3706 email: sw-fac@dtcc.edu• Terry Campus: 302-857-1040 email: terry-fa@dtcc.edu• Wilmington Campus: 302-434-5552 email: sw-fac@dtcc.eduA. Student InformationLast name First name M.I. Student ID #Address (include apt. #)City/State/Zip codeDate of birthPhone # (include area code)B. Supplemental Nutrition Assistance Program (SNAP)Please select one of the following statements: I received SNAP benefits during 2011 or 2012. My parent(s) received SNAP benefits during 2011 or 2012. Neither my parents or I received SNAP benefits during 2011 or 2012.C. Child Support PAIDDo not include support paid for children included in your parent(s) household size.Please select one of the following statements: I paid child support in 2012. Provide documentation My parent(s) paid child support in 2012. Provide documentation Neither my parent(s) or I paid child support in 2012.Name of Person to Whom ChildSupport Was Paid:Name of Child for Whom Support Was Paid:Amount Paid in2012:

Student Name: ____________________________Student’s ID #: (700)______________D. Identity and Statement of Educational PurposeThe student must appear in person at Delaware Technical Community College to verify his or heridentity 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 thestudent’s photo ID that is annotated with the date it was received and the name of the official at theinstitution authorized to collect the student’s ID.In addition, the student must sign, in the presence of the institutional official, the following:Statement of Educational PurposeI certify that I _____________________________ am the individual signing this(Print Student’s Name)Statement of Educational Purpose and that the federal student financial assistanceI may receive will only be used for educational purposes and to pay the cost of attendingDelaware Technical Community College for 2013–2014._________________________________________ _______________(Student’s Signature)(Date)______________________(Student’s ID Number)If the student is unable to appear in person at Delaware Technical Community College to verify his orher identity, the student must provide a copy of the valid government-issued photo identification (ID)that is acknowledged in the notary statement below, such as but not limited to a driver’s license, otherstate-issued ID, or passport; andNotary’s Certificate of AcknowledgementState of __________________________________City/County of ____________________________On________________________, before me, ____________________________________________,(Date)(Notary’s name)personally appeared, ____________________________________________, and provided 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)________________________________________________(Notary signature)My commission expires on __________________________(Date)

Student Name: ____________________________Student’s ID #: (700)______________E. High School Completion StatusWe need verification of your high school completion status. Check a statement below and providedocumentation.When you begin college in 2013–2014 your high school completion status is: High school diploma. Final official high school transcript that shows the date diploma was awarded. General Educational Development (GED) certificate or GED transcript. Academic transcript that indicates successful completion of at least a two-year program that isacceptable for full credit toward a bachelor’s degree. State issued homeschooled certification credential. Transcript or the equivalent, signed by the student’s parent or guardian, that lists the secondaryschool courses the student completed and documents the successful completion of a secondaryschool education in a homeschool setting.F. CertificationBy signing this worksheet, I (we) certify that all the information reported on all pages of this worksheet is complete and correct. I(we) understand that if I (we) purposely give false or misleading information, I (we) may be fined, or sentenced to jail, or both.X __________________________________________________________StudentX___________________________________________________________Parent_____________________________Date_____________________________Date