College of DuPage
Office of Student Financial Assistance
2015-2016 V1 Worksheet Dependent
Last Name:
Student ID:
First Name:
____________
Your 2015-2016 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 – Please list the people in your parent(s) household that your parent(s) financially support more than 50%.
This includes:
 Yourself
 Your parent(s), including a step-parent, even if you do not live with your parent(s).
 Your parent’s other children if your parent(s) will provide more than 50% of their support from July 1, 2015
through June 30, 2016, or if the other children would be required to provide parental information if they were
completing a FAFSA for 2015-2016. Include children who meet either of these standards, even if the children do
not live with your parent(s).
 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 through June 30, 2016.
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, 2015 and June 30, 2016.
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 you
Sister
Name of
College
Will be Enrolled at
Least Half Time
Yes
College of DuPage
1.
2.
3.
4.
5.
6.
B. In 2013 or 2014, 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 2014? Answer yes, even if you were paid in cash.
YES
NO
YES
NO
2) Did you file a 2014 Federal Tax Return?
* If a foreign tax return was filed, please provide us with a copy of
the translated foreign tax return.
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Student’s Name:
ID:
3) IF YOU DID NOT FILE A 2014 FEDERAL TAX RETURN BUT WORKED, attach copies of all 2014 IRS W2 and/or 1099
forms.
EMPLOYER’S NAME
Suzy’s Auto Body Shop (example)
2014 income
$2,000.00(example)
W2/1099 Attached?
Yes (example)
1.
2.
3.
D. Parent Income and Tax Information – Answer each question as it applies to the parent(s) whose information you
listed on your 2015-2016 FAFSA and are included in Section A:
1) Did your parent(s) work in 2014? Answer yes, even if paid in cash.
YES, parent 1
YES, parent 2
NO, parent 1
NO, parent 2
2) Did your parent(s) file a 2014 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 2014 FEDERAL TAX RETURN BUT WORKED, attach copies of all 2014 IRS W2
and/or 1099 forms.
1.
2.
3.
4.
5.
PARENT’S NAME
Jane Doe (example)
EMPLOYER’S NAME
Suzy’s Auto Body Shop (example)
2014 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).
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