2015-2016 WVNCC Dependent Verification Worksheet
_____________________________
__________________________
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Student’s: Last Name
First Name
M.I.
N_________________
DV3
Student ID #
Email Address: _______________________________@mail.wvncc.edu – All correspondence from our office will be sent here
Your FAFSA was selected for review in a process called “Verification.” In this process WVNCC
is required to compare information from your FAFSA with other documentation. The law says
we have a right to ask you for this information before awarding federal aid. If there are
differences between your FAFSA and your financial documents we may need to send corrections
electronically to have your information reprocessed.
A. Child Support Paid
What you should do


Complete this worksheet. ALL SECTIONS MUST BE FILLED IN.
Write N/A (not applicable) or enter a zero if the field does
not pertain to you. You and at least one parent/step-parent
MUST sign the worksheet.
Send or take the completed worksheet to the Financial Aid
Office or your Campus Service Center at WVNCC.
One of the parent(s)/step-parent included in the household or the student paid
We must review the requested information under the financial aid program rules (CFR
Title 34, Part 668).
child support in 2014. List below the names of the persons who paid the child
support, the names of the persons to whom the child support was paid, the names
of the children for whom the child support was paid, and the total annual amount of child support that was paid in 2014 for each child.
Be sure to enter zeros if no funds were paid.
Name of Person Who Paid
Child Support in 2014
Name of Person to Whom Child
Support was Paid in 2014
Name of Child for Whom
Support Was Paid in 2014
Marty Jones
Chris Smith (example)
Terry Jones
Amount of Child
Support Paid in
2014
$6,000.00
If you need more space, attach a separate page that includes the student’s name and Social Security Number at the top.
If we have reason to believe that the information regarding child support paid is not accurate, we may require additional documentation, such as:

A copy of the separation agreement or divorce decree that shows the amount of child support to be provided;

A statement from the individual receiving the child support certifying the amount of child support received; or

Copies of the child support payment checks or money order receipts.
B. Certification and Signatures
By signing this worksheet, we (the student and parent/step-parent) certify the information reported is complete and correct. At least one parent
/step-parent must sign. Warning: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both,
and/or the student may be subject to disciplinary action as stated in WVNCC’s Student Code of Conduct Rule.
We certify that child support was paid in 2014. We have listed above the names of the persons to whom the child support was paid, the names
of the children for whom the child support was paid and the total amount of child support paid in 2014 for each child. We also attest that we
have not included these children as members of the household on the FAFSA. (Parents can either include these children as members of the
household *or* include the amount of child support paid but may not include these children as members of the household and also list child
support paid.)
_________________________________________________
_________________________________
Student’s Signature
Date
_________________________________________________
_________________________________
Parent’s/Step-Parent Signature
Date
WVNCC
Financial Aid Office
1704 Market St., Wheeling, WV 26003