College of DuPage Office of Student Financial Assistance Last Name: Student ID: First Name: 2016 – 2017 Asset Verification A review of your 2016‐2017 Free Application for Federal Student Aid (FAFSA) results has determined we must request asset information. Please complete the following information. Do not leave questions blank. To provide additional explanations, use the back side of the form, if necessary. Your response is required for our office to proceed with our review and decision. If you have questions regarding this request, please contact our office at (630) 942‐2251. Please report the items checked below as of the date you originally completed your 2016‐2017 FAFSA Type of Asset Student (and Spouse) Parent(s) Cash, savings and checking accounts $ $ Investments net worth (Do not include the home you live in) $ $ Business/Farm Net Worth $ $ Other real estate (Do not include the home you live in). Address of property #1 Market Value $ Mortgage Owed $ Address of property #2 Market Value $ Mortgage Owed $ If you have more than two properties make additional copies of this form. Net worth means current value minus debt. If the net worth is negative, enter 0. Investments include trust funds, UGMA and UTMA accounts, money market funds, mutual funds, certificates of deposit, stocks, stock options, bonds, other securities, Coverdell savings accounts, 529 college savings plans, the refund value of 529 state prepaid tuition plans, installment and land sale contracts (including mortgages held), commodities, etc. Investment value means the current balance or market value of this investment. Investment debt means only those debts that are related to the investments. Investments do not include the home in which you live, the value of life insurance and retirement plans (401(K) plans, pension funds, annuities, non‐
education IRAs, Keogh plans, etc.), or cash savings, checking accounts already reported on the FAFSA, and UGMA and UTMA accounts for which you are the custodian, but not the owner. Business/Farm value includes the market value of land buildings, machinery, equipment, inventory, etc. Business debt means only those debts for which the business was used as collateral. Business value does not include the value of a small business that you (your spouse and/or your parents) own and control and that has 100 or fewer full‐time equivalent employees. Do not include the value of a family farm that you (your spouse and/or your parents) live on and operate. Other Real Estate includes rental property, land, and second or summer homes. This does not include the home you and/or your parents live in. Determine the market value by using the price you would ask for if the property were put on the market for sale. CERTIFICATION: I/WE certify that all information on this form is true, complete and accurate. Upon request I agree to provide additional proof of the information reported on this form. Warning: If you purposely give false or misleading information, you may be fined up to $20,000, sent to prison, or both. Student Signature Date Parent Signature (if dependent) Date Please return this form to: College of DuPage, Office of Student Financial Assistance – SSC 2220 425 Fawell Blvd., Glen Ellyn, IL 60137 FAX (630) 942‐2151 EMAIL: financialaid@cod.edu The college will not discriminate in its programs and activities on the basis of race, color, religion, creed, national origin, sex, age, ancestry, marital status, sexual orientation, arrest record, military status or unfavorable military discharge, citizenship status, physical or mental handicap or disability (Board Policy 5010; 20‐5). 2016‐2017 Asset Verification Form
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