Office of Financial Aid
5400 Ramsey Street Fayetteville, NC 28311
Telephone: (910) 630-7192/7193
1-800-488-7110
Fax: (910) 630-7285
Website: http://www.methodist.edu/Financial_Aid/index.htm
V4
2016-2017 Verification
Directions:
Your FAFSA form was selected by the U.S. Dept. of Education
for review in a process called “verification”. In this process, we
are required by federal law (34 CFR, Part 668) to compare
the information from your FAFSA form with the information
provided on this form. If there are differences between your
FAFSA form and the documents you’ve submitted, corrections
may be needed. We cannot process your financial aid
until verification has been completed.
What you should do:
1.Contact us if you have questions about this form.
2.Submit this completed worksheet, and any other documents to our office.
3.Please make sure this form is completed and signed by you (if independent
student) and a parent (if dependent student).
Section A: Student Information (Please Print)
______________________________________________________________________________________
Last Name
First Name
M.I.
MU Student ID
Date of Birth
___________________________________________________________________________________________________________________
Address (include apt. #)
City
State
Zip
___________________________________________________________________________________________________________________
Email address
Contact Phone Number (include area code)
_________________________________________ ________________
Drivers License # Drivers License State
Check if student will be on campus p
or off campus p
Section B: Other Information to verify- Supplemental Nutrition Assistance Program or SNAP (formerly food stamps)
The Student (if Independent student) / Parent (if Dependent student) certifies that _______________________________________,
a member of the student’s household, received benefits from the Supplemental Nutrition Assistance Program (SNAP) sometime during
2014 or 2015. SNAP may be known by another name in some states. For assistance in determining the name used in a state, please
call 1-800-4FED-AID (1-800-433-3243).
Note: If we have reason to believe that the information regarding the receipt of SNAP benefits is inaccurate, we may require
documentation from the agency that issued the SNAP benefits in 2014 or 2015.
Section C: Child Support Paid
If the Student and/or Spouse (if Independent student) / Parent (if Dependent student), who is a member of the student’s household,
paid child support in 2015, provide in the space 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 and ages of the children for whom the
child support was paid, and the total annual amount of child support that was paid in 2015 for each child.
If more space is needed, provide a separate page that includes the student’s name and ID number at the top.
Name of Person Who Paid Child
Support
Person to Whom Child
Sup­port was Paid
Example: Tom Smith
Kim Smith
Child Support Paid
Name and age of Child for Whom
Support was Paid
Name
Age
Blake Smith
Amount of Child Support Paid in
2015
2
$2000.00
Total Amount of $
Note: If we have reason to believe that the information regarding child support paid is inaccurate, we may require
additional documentation, such as:
• A signed statement from the individual receiving the child support certifying the amount of child support received; or
• Copies of the child support payment checks, money order receipts, or similar records of electronic payments having been made.
continued on page 2
Student Name
Student MU I.D. #
Page 2
Section D: High School Completion Status Verification
Provide one of the following documents that will indicate the student’s 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 state certificate or transcript the student received by the student after a student passed a State-authorized examination (GED test, HiSET, TASC, or other State-authorized
examination) that the State recognizes as the equivalent of a high school diploma.
• For students who completed secondary education in a foreign country, a copy of the “secondary school leaving certificate” or other similar document.
• 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.
• For a student who was homeschooled in a state where state law requires the student to obtain a secondary school completion credential for homes school (other than a high
school diploma or its recognized equivalent), a copy of that credential.
• For a student who was a homeschooled student in a state where state law does not require the student to obtain a secondary school completion credential for home school
(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 includes a statement that the student successfully completed a secondary school education in a home school setting.
Contact the Methodist University Office of Financial Aid if you are unable to obtain the documentation listed above.
Section E: The Statement of Identity and Educational Purpose
The Statement of Identity and Educational Purpose MUST be signed in the presence of Methodist University, Office of Financial Aid official or be
notarized if unable to appear in person.
Identity and Statement of Educational Purpose
( To Be Signed at the Institution)
The student must appear in person at Methodist University to verify his or her identity by presenting an unexpired 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 by the institution with the date it was
received and reviewed, and the name of the official at the institution authorized to receive and review the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose provided below.
I certify that I_ ___________________________ (Print Students Name) am the individual signing this 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 attending Methodist University for 2016-2017.
_________________________________________
Student’s Signature
______________________
Date
___________________________
Student’s MU ID Number
As the authorizing official for Methodist University, the above named student’s signature and Identification were received and reviewed in my
presence. A copy of unexpired valid government – issued photo ID is on file in the Office of Financial Aid.
_______________________________
MU Authorizing Official Signature __________
Date ___________________________
Type of unexpired government–issued photo ID provided.
Identity and Statement of Educational Purpose
(To Be Signed In the Presence of a Notary IF UNABLE to appear in person)
If the student is unable to appear in person at Methodist University to verify his or her identity, the student must provide the institution:
(a) A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged in the notary statement below, or that is presented to a notary, such as,
but not limited to , a driver’s license, other state-issued ID, or passport: and
(b) The original Statement of Educational Purpose provided below, which must be notarized. If the notary statement appears on a separate page than the Statement of
Educational Purpose there must be a clear indication that the Statement of Educational Purpose was the document notarized..
Statement of Educational Purpose
I certify that I________________________________ (Print Student’s Name) am the individual signing this 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 attending Methodist University for 2016-2017.
_________________________________________
______________________ ___________________________
Student’s Signature
Date
Student’s MU ID Number
Notary’s Certificate of Acknowledgement (if unable to appear in person)
State of:___________________________ City /County of:___________________On_____________________________(Date), before me,
(Notary’s Name) ____________________________, personally appeared(Print name of signer)______________________________________ and
provided to me on basis of satisfactory evidence of identification(Type of unexpired government-issued photo ID provided) ______________________
to be the above-named person who signed the forgoing instrument. WITNESS my hand and official seal:_________________(Notary Signature)
(seal)
My commission expires on: __________________________(Date)
Section F: Certification and Signatures
•
•
Each person signing below certifies that all of the information reported is complete and correct. The student and one parent whose information was reported on the
FAFSA must sign and date below.
By signing this form, I (we) also understand that this information may require Methodist University to make changes to the originally reported FAFSA data that resulted
from the verification process. Warning: If you purposely give false or misleading information you may be fined, be sentenced to jail,
or both. Please complete this worksheet, both student and parent (if dependent student) must sign
Student Signature_________________________________________________________
Date____________________________
Parent Signature_________________________________________________________
(Dependent Students only)
Date____________________________
You should make a copy of the worksheet for your records. Do not mail this worksheet to the U.S. Department of Education.
Submit this worksheet to: Methodist University, Office of Financial Aid, 5400 Ramsey Street, Fayetteville, NC 28311-1498
* MUST BE ORIGINAL (Cannot be faxed or scanned) *