Office of Student Financial Aid
Murphy Fax: 770-537-7995
Carroll Fax: 770-838-3244
Newnan Fax: 770-755-7881
Email: FinancialAid@westgatech.edu
A Unit of the Technical College System of Georgia
2016-2017 VERIFICATION WORKSHEET
Your 2016-2017 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. If
information on your FAFSA is incorrect we might need to make corrections. Corrections might alter your financial aid eligibility.
Complete this verification form and submit it with all required financial documents as soon as possible to the Financial Aid Office.
Please make sure you read and understand all items you are completing and if necessary, review your completed FAFSA. Incomplete
documents will delay processing. Please allow 4-6 weeks processing time before awards can be viewed on your Self- Service Banner
Web account. Complete your file prior to the semester deadlines to ensure available funding at the start of the term.
Section A: Student Information
Last Name
First Name
MI
Street Address (include apt. no.)
ID #/Social Security #
Date of Birth
City
State
Zip Code
Phone Number (with area code)
Section B: Family Information
INDEPENDENT STUDENTS
(You were not required to provide parental data
on the FAFSA)
Include: yourself, your spouse, your children, and any other person if they meet the
following criteria:




they now live with you, and
you provide more than half of their support, and
you will continue to provide this support between July 1, 2016 and June 30, 2017.
Also list the name of the college for any household member who will be enrolled at least
half-time in a postsecondary school between July 1, 2016 and June 30, 2017.
If more space is needed, attach a separate page with your name and student ID at the top.
DEPENDENT STUDENTS
(Your parent information was required on the
FAFSA)
Include: yourself and your parents/stepparents, and any other person if they meet
the following criteria:



they now live with your parents, and
they now get more than half of their support from your parents, and
they will continue to get this support between July 1, 2016-June 30, 2017.
If more space is needed, attach a separate page with your name and student ID at the top.
Full Name
Age
Relationship
College
Self
West Georgia Technical College
Section C: Other Information
Did anyone listed in Section B of this worksheet receive
Food Stamps any time during 2014 or 2015?
Yes
No
Name of Person Who Paid
Child Support
Name of Person Whom Child
Support was Paid
Did anyone listed in Section B of this worksheet pay
child support in 2015? If yes, please complete the chart below.
Yes
No
Name of Child Whom Support
Was Paid
Amount of Support Paid
in 2015
Section D: 2015 Income Information
Was a 2015 federal tax return or extension filed for each:
All Students:
For Dependent Students Only:
Student: □ yes □ filed extension □ no
Mother/Stepmother: □ yes □ filed extension □ N/A □ no
Spouse: □ yes □ filed extension □ no □ N/A
Father/Stepfather: □ yes □ filed extension □ N/A □ no
1.
2.
If “yes” was selected by any person above and that person did not use the IRS Data Retrieval Tool, their 2015 IRS Tax
Return Transcript must be submitted.
 To obtain an IRS Tax Return Transcript, go to www.IRS.gov and click on the “Order a Return Transcript” link or call 1800-908-9946. (We cannot accept a copy of tax returns)
If “no” was selected by any person above, attach all W-2 forms and complete the chart below.
Check here, if not required to file but
earned income
Student
Spouse
Mother/Stepmother
Father/Stepfather
Source of Income/Employer
□ yes □ no
□ yes □ no
□ yes □ no
□ yes □ no
2015 Total Income Earned
$
$
$
$
Section E: Certification and Signature
Each person signing this form certifies that all the information on it is complete and correct.
Warning: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
If the student is Dependent, one parent whose information was reported on the FAFSA must sign and date.
Student’s Signature
Parent’s Signature (if dependent)
Date
Parent’s Printed Name
Date
As set forth in its student catalog, West Georgia Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender,
religion, disability, age, political affiliation or belief, genetic information, veteran status, or citizenship status (except in those special circumstances permitted or
mandated by law).
Equity (Title IX) Coordinator, Dr. Tonya Whitlock, Vice President for Student Affairs, tonya.whitlock@westgatech.edu, 401 Adamson Square, Carrollton, GA 30117,
678.664.0532.
ADA (Section 504) Coordinator, Dr. Rick Leveille, Vice President for Administrative Services, rick.leveille@westgatech.edu, 401 Adamson Square, Carrollton, GA
30117, 678.664.0533.
Verification Form - Revised: 5/18/2016