College of DuPage 2016‐2017 V1 Worksheet Independent Office of Student Financial Assistance Last Name:
College
of
DuPage
`
Office
of
Student
Financial
Assistance
Last
Name:
2016
‐
2017
V1
Worksheet
Independent
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.
A.
Household Size – In the box below, please list the people in your household that you (and if married, your spouse) financially support more than 50%.
The following people should be included:
Yourself
Your spouse, if married at the time you originally submitted your FAFSA
You or your spouse’s children if you and/or your spouse will provide more than 50% of their support from July 1,
2016 through June 30, 2017, even if the children do not live with you and/or spouse.
Support includes, but is not limited to, housing, clothes, medical, dental, transportation, payment of college costs, etc.
Other people if they now live with you and/or your spouse and you and/or your spouse 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.
Include the name of the college for any household member 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 Age Relationship to student
Name of
College
Will be Enrolled at
Least Half Time
Missy Jones (example) 18 Sister College of DuPage Yes
1.
2.
3.
4.
5.
6.
B.
In 2014 or 2015 , did you or anyone in your 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
2) Did you file a 2015 Federal Tax Return?
YES
NO
NO
2016 ‐ 2017 V1 Worksheet Independent 1 02/02/16
Student’s Name: ID:
* If a foreign tax return was filed, please provide us with a copy of the translated foreign tax return.
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 2015 income W2/1099 Attached?
Suzy’s Auto Body Shop (example) $2,000.00(example) Yes(example)
1.
2.
3.
D.
Spouse
Income
and
Tax
Information
– Answer each question as it applies to the spouse whose information you listed on your 2016 ‐ 2017 FAFSA and is included in Section A:
1) Did your spouse work in 2015?
Answer yes, even if paid in cash.
3.
4.
5.
Suzy’s Auto Body Shop (example)
1.
2.
YES
NO
2) Did your spouse file a 2015 Federal Tax Return?
YES NO
* If a foreign tax return was filed, please provide us with a copy of
the translated foreign tax return.
3)
IF
YOUR
SPOUSE
DID
NOT
FILE
A
2015
FEDERAL
TAX
RETURN
BUT
WORKED,
attach copies of all 2015 IRS W2
and/or 1099 forms.
EMPLOYER’S NAME
2015 income W2/1099 Attached?
$2,000.00
(example) 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
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 Independent 2 02/02/16
