College of DuPage Office of Student Financial Assistance 2016‐2017 V1 Worksheet Dependent Last Name: First Name: Student ID: Your 2016‐2017 Free Application for Federal Student Aid (FAFSA) was selected for “VERIFICATION” by the Federal Processor/Institution. This means we are required to confirm the information you reported on your FAFSA. If there is conflicting information, we may make a correction to your FAFSA and/or ask for additional information. Failure to submit requested documents will result in your financial aid not being processed. If you have questions about verification, contact the College of DuPage Office of Student Financial Assistance as soon as possible so that your financial aid will not be delayed. NOTE: Please answer each question as it applies to the student and parent(s) whose information is on the FAFSA. A. Household Size – In the box below, please list the people in your parent(s) household that your parent(s) financially support more than 50%. The following people should be included:  Yourself  Your parent(s), including a step‐parent, as reported on the FAFSA.  Your parent’s other children if your parent(s) will provide more than 50% of their support from July 1, 2016 through June 30, 2017, or if the other children would be required to provide parental information if they were completing a FAFSA for 2016‐2017. Include children who meet either of these standards, even if the children do not live with your parent(s). Support includes, but is not limited to, housing, clothes, medical, dental, transportation, payment of college costs, etc.  Other people if they now live with your parent(s) and your parent(s) provide more than 50% of their support and will continue to provide more than 50% of their support from July 1, 2016 through June 30, 2017. Support includes, but is not limited to, housing, clothes, medical, dental, transportation, payment of college costs, etc. Also include the name of the college for any household member, excluding your parent(s,) who will be enrolled at least half time in a degree, diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, 2016 and June 30, 2017. If more space is needed, attach a separate page with the student’s name and Student ID at the top. Full Name Missy Jones (example) Age 18 Relationship
to student Sister
Name of College College of DuPage Will be Enrolled at
Least Half Time Yes
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B. In 2014 or 2015, did you or anyone in your parent(s) household (those listed in Section A of this form) receive benefits from the Supplement Nutrition Assistance Program (SNAP)? YES NO C. Student Income and Tax Information – Answer each question as it applies to you: 1) Did you work in 2015? Answer yes, even if you were paid in cash. YES NO YES NO 2) Did you file a 2015 Federal Tax Return? * If a foreign tax return was filed, please provide us with a copy of the translated foreign tax return. 2016‐2017 V1 Worksheet Dependent 1 02/02/16 Student’s Name:
ID:
3) IF YOU DID NOT FILE A 2015 FEDERAL TAX RETURN BUT WORKED, attach copies of all 2015 IRS W2 and/or 1099 forms. EMPLOYER’S NAME Suzy’s Auto Body Shop (example)
2015 income $2,000.00(example) 1. 2. 3. W2/1099 Attached?
Yes (example)
D. Parent Income and Tax Information – Answer each question as it applies to the parent and/or step‐parent(s) whose information you listed on your 2016‐2017 FAFSA and are included in Section A: 1) Did your parent(s) work in 2015? Answer yes, even if paid in cash. YES, parent 1 NO, parent 1 YES, parent 2 NO, parent 2 2) Did your parent(s) file a 2015 Federal Tax Return? * If a foreign tax return was filed, please provide us with a copy of the translated foreign tax return. YES, parent 1 YES, parent 2 NO, parent 1 NO, parent 2 3) IF YOUR PARENT(S) DID NOT FILE A 2015 FEDERAL TAX RETURN BUT WORKED, attach copies of all 2015 IRS W2 and/or 1099 forms. PARENT’S NAME Jane Doe (example) 1. 2. 3. 4. 5. EMPLOYER’S NAME
Suzy’s Auto Body Shop (example)
2015 income $2,000 (example) W2/1099 Attached?
Yes (example)
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 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 V1 Worksheet Dependent 2
02/02/16