Financial Aid Office
414 N Meridian St. # 6068 · Newberg OR 97132
Phone: 503.554.2302 · Fax: 503.554.3110
Toll Free: 1-800-765-4369
2016-2017 VERIFICATION WORKSHEET (V1)
STEP 1 - STUDENT INFORMATION
_________________________ _________________________ ____________________ ____________________
Last Name
First Name
Last 4 digits: SSN
Student ID Number
___________________________________________________ ____________________ ____________________
Permanent Address
Street & Number
City/State/Zip
Date of Birth
_______________________________ __________________________________ __________________________
Permanent Phone Number (include Area Code)
Cell Phone Number (include area code)
STEP 2 - HOUSEHOLD INFORMATION
If you are a dependent student, include:
• Yourself
• Biological or Adoptive Parent(s), Step-parent(s) that live in
your household
• Your parent(s)’ other dependent children if a) your parent(s)
will provide more than half of their support from July 1, 2016,
through June 30, 2017, or b) the children would be required
to provide parental information when applying for Federal
Student Aid
• Other people only if they now live in your parent’s household
and your parents will provide more than half of their support
from July 1, 2016 through June 30, 2017
Full Name
Age
STUDENT
Email Address
If you are an independent student, include:
• Yourself
• Your spouse (if you are married)
• Your children if you will provide more than half of their
support from July 1, 2016, through June 30, 2017
• Other people only if they live in your household and you
provide more than half of their support and will continue to
do so from July 1, 2016, through June 30, 2017
Relationship
Self
In 2016-17 year, list school for those enrolled at
least half time in College/Degree Program
George Fox University
STEP 3 - STUDENT TAX FORMS & INCOME INFORMATION - CALENDAR YEAR 2015
Check only one of the boxes below, then…
I filed or will file a 2015 Federal Income Tax Return
I worked but am not required to file a 2015 Federal
Income Tax Return. Note: Work-study is work and a W-2 was
either sent to your permanent address or is available online
through your MyGFU.
I did not work and will not file a 2015 Fed 1040 tax form.
Submit the following required documents
Once tax return is filed, update FAFSA online by selecting the IRS Data
Retrieval option, if eligible, OR send us your 2015 IRS Tax Return
Transcript. Go to www.irs.gov and use “Get a Tax Transcript” tool. Note:
You will need to wait 3-4 weeks after online tax filing, longer if you mail in
a paper tax form.
Provide copies of your 2015 W-2 form(s) and list your earnings here. If you have
misplaced your W-2(s) you should request duplicates from your employer(s).
Proceed to Step 4
STEP 4 - SPOUSE OR PARENT TAX FORMS & INCOME INFORMATION - CALENDAR YEAR 2015
Submit the following required documents
Check only one of the boxes below, then…
STEP 4 - SPOUSE OR PARENT TAX FORMS &
Once tax return is filed, update FAFSA online by selecting the IRS Data Retrieval
option, if eligible, OR send us your 2015 IRS Tax Return Transcript. Go to www.irs.gov
and use “Get a Tax Transcript” tool. Note: You will need to wait 3-4 weeks after
online tax filing, longer if you mail in a paper tax form.
I filed or will file a 2015 Federal Income Tax Return
Provide copies of your 2015 W-2 form(s) and list your earnings here. If you have
misplaced your W-2(s) you should request duplicates from your employer(s)
I worked but am not required to file a 2015 Federal
Income Tax Return. Note: Work-study is work and a W-2
was either sent to the permanent address or is available
through the student’s MyGFU.
I did not work and will not file a 2015 Fed 1040 tax form.
Proceed to Step 5
STEP 5 - VERIFICATION OF CHILD SUPPORT PAID
Did you or someone in your household pay child support in 2015?
Yes
No
If yes, complete the section below, sign and return to Financial Aid Office. If no, proceed to step 6.
If more space is needed, provide a separate page that includes the student’s name and ID number at the top.
Age of
Child for
Amount of Child
Name of Person Who Paid Name of Person to Whom
Name of Child for Whom
Whom
Support Paid in
Child Support
Child Support was Paid
Support Was Paid
Support
2015
Was Paid
$
$
$
$
$
STEP 6 - VERIFICATION OF FOOD STAMP (SNAP) BENEFITS
Did student receive Food Stamp (SNAP) Benefits in 2014 or 2015?
No
Yes
Did parent receive Food Stamp (SNAP) Benefits in 2014 or 2015?
No
Yes
Untaxed Income (Payments to tax deferred retirement plans, child support received, clergy housing allowance, Veterans non-educational
benefits.)
STUDENT $__________ SOURCE(S): _____________________
PARENT/SPOUSE $____________ SOURCE(S): _____________________________
STEP 7 - CERTIFICATION: By signing this worksheet, I certify all the information reported is complete and correct.
_____________________________________________________________________________________________
Student Signature
Date
Student Name (Please Print)
_____________________________________________________________________________________________
Parent Signature (If student is dependent)
Date
Parent Name (Please Print)
Note: Incomplete forms will be returned which may cause a delay in your financial aid being finalized in time for disbursement.
Financial Aid Office
414 N. Meridian St. #6068 . Newberg, OR 97132
Phone: 503.554.2302 Fax: 503.554.3110
Toll Free: 1.800.765.4369
HIGH SCHOOL COMPLETION STATUS
(V5.2)
STUDENT INFORMATION
______________________ _____________________ _______________________ ________________________
Last Name
First Name
Last 4 digits: SSN
Student ID Number
______________________________________________ ____________________ ________________________
Permanent Address
Street & Number
City/State/Zip
Date of Birth
______________________________ ________________________________ ____________________________
Permanent Phone Number (include Area Code)
Cell Phone Number (include area code)
Email Address
High School Completion Status
Please complete the above section and attach one of the following documents that indicate your high school
completion status when you begin college in 2016–2017:

A copy of the student’s high school diploma.

A copy of the student’s final official high school transcript that shows the date when the diploma was awarded.

A copy of the student’s General Educational Development (GED) certificate or GED transcript.

An academic transcript that indicates the student successfully completed at least a two-year program that is
acceptable for full credit toward a bachelor’s degree.

If State law requires a homeschooled student 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 State law does not require a homeschooled student 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 the student's parent or guardian, that lists the secondary school courses the student completed and documents
the successful completion of a secondary school education in a homeschool setting.
If you are unable to obtain the documentation listed above, please contact the financial aid office.
Return (this form) by mail to: George Fox University, 414 N. Meridian #6068, Newberg, OR 97132
George Fox University
414 N. Meridian St. #6068. Newberg, OR 97132
Phone: 503.554.2302 . Fax: 503.554.3110
Toll Free: 1.800.765.4369
IDENTITY AND STATEMENT
OF EDUCATIONAL PURPOSE
(V5.3)
STUDENT INFORMATION
______________________ _______________________ ______________________ _______________________
Last Name
First Name
Last 4 digits: SSN
Student ID Number
______________________________________________ _____________________ _______________________
Permanent Address
Street & Number
City/State/Zip
Date of Birth
_______________________________ _________________________________ __________________________
Permanent Phone Number (include Area Code)
Cell Phone Number (include area code)
Email Address
Identity and Statement of Educational Purpose
(To be signed at George Fox University)
The student must appear in person at George Fox University 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 with the date it was received
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 following:
Statement of Educational Purpose
I certify that I _________________________________ am the individual signing this
Print Student Name
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
attendance at George Fox University for 2016-2017.
__________________________________________________________________________________________
Student Signature
Date
Student Name (Please Print)
If you are unable to appear in person at George Fox University, please see reverse page for certifying with Notary.
Identity and Statement of Educational Purpose
(To Be Signed With Notary)
If the student is unable to appear in person at George Fox University 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, such as but not limited to a driver’s license, other state-issued ID, or passport; and
(b) The original notarized Statement of Educational Purpose provided below.
Statement of Educational Purpose
I certify that I _____________________________ am the individual signing this
Print Student Name
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
attendance at George Fox University for 2016-2017.
__________________________________________________________________________________________
Student Signature
Date
Student Name (Please Print)
Notary’s Certificate of Acknowledgement
State 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)
If using this form, please return by mail to: Financial Aid Office, George Fox University, 414 N. Meridian St. #6068, Newberg, OR 97132