2015 - 2016 Dependent Student Verification Worksheet (V6)
Your application was selected for review in a process called Verification. You will need to provide certain documents as
part of this process. The law says we have the right to ask you for this information before awarding federal financial aid (34
CFR, Part 668). The Campus will correct electronically any differences between your application for financial aid and your
financial documents. It is important to complete this process as soon as possible. No financial aid decision will be made
unless all required steps are complete, all required information is accurate and all eligibility requirements are met.
For the purposes of this Verification Worksheet, “Parent” includes natural parent, adoptive parent and/or stepparent.
“Parent” does not mean grandparent(s), foster parent or legal guardian.
What you should do.
Collect your and your parent(s)’ 2014 financial documents including, but not limited to, federal tax forms,W-2’s,
tax schedules, 1099’s, workers’ compensation, child support received or paid, etc..
Complete this worksheet using the information on your and your parent(s)’ financial documents.
Both you and one of your parents must sign this worksheet and all financial documents.
Return this worksheet plus all related documents to the Financial Aid Office.
Need assistance?
Contact the Financial Aid Office at:
Georgetown Campus:
302-259-6080
Stanton Campus:
302-453-3706
Dover Campus:
302-857-1040
Wilmington Campus:
302-434-5552
email: owens-finaid@dtcc.edu
email: sw-fac@dtcc.edu
email: terry-fa@dtcc.edu
email: sw-fac@dtcc.edu
A. Student Information
Last name
First name
M.I.
Student ID #
Address (include apt. #)
Date of birth
City/State/Zip code
Phone # (include area code)
B.
Family Information -
“Parent” includes natural parent, adoptive parent and/or stepparent.
List the people in your parents’ household. Include yourself, your parent(s) (including your stepparent) even if you don’t live
with your parents, your parents’ other children, even if they don’t live with your parents, if (a) your parents will provide
more than half of their support from July 1, 2015 through June 30, 2016, or (b) the children would be required to provide
parental information when applying for federal student aid, and other people if they now live with your parents and your
parents provide more than half of their support and will continue to provide more than half of their support from July 1, 2015
through June 30, 2016.
Write the names of all household members in the space(s) below. Include the name of the college for any
household member, excluding your parents, who will be attending college at least half time between July 1, 2015
and June 30, 2016, and will be enrolled in a degree, diploma or certificate program. If you need more space, attach
a separate page
Full name
Age
Relationship
College
Self
Delaware Tech
Student Name: ____________________________
Student’s ID #: (700)______________
C. 2014 Untaxed Income
All information reported is for the entire year of 2014. Do not leave any questions blank.
Student
Parent
a.
$
b.
$
c.
$
$
d.
Payments to tax-deferred pension and retirement savings plans (paid directly or
withheld from earnings), including, but not limited to, amounts reported on the W-2
forms in Boxes 12a through 12d, codes D, E, F, G, H and S. Don’t include amounts
reported in code DD (employer contributions toward employee health benefits.)
IRA deductions and payments to self-employed SEP, SIMPLE, Keogh and other
qualified plans from IRS Form 1040 –line 28 + line 32 or 1040A line 17.
Child support received for any of your (or your parents’) children. Don’t include
foster care or adoption payments.
Tax exempt interest income from IRS Form 1040 line 8b or 1040A line 8b
$
$
$
e.
$
$
$
$
$
$
$
Untaxed portions of IRA distributions from IRS Form 1040 lines (15a minus 15b) or
1040A lines (11a minus 11b). Exclude rollovers. If negative, enter a zero here.
f. Untaxed portions of pensions from IRS Form 1040 lines (16a minus 16b) or 1040A
lines (12a minus 12b). Exclude rollovers. If negative, enter a zero here.
g. Housing, food and other living allowances paid to members of the military, clergy
and others (including cash payments and cash value of benefits). Don’t include the
value of on-base military housing or the value of a basic military allowance for
housing.
h. Veterans’ noneducation benefits such as Disability, Death Pension, or Dependency &
Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances.
i. Other untaxed income not reported in items 45a through 45h (or items 94a through
94h for parent), such as workers’ compensation, disability, etc. Also include the
untaxed portions of health savings accounts from IRS form 1040 line 25. Don’t
include extended foster care benefits, student aid, earned income credit, additional
child tax credit, welfare payments, untaxed Social Security benefits, Supplemental
Security Income, Workforce Investment Act educational benefits, on-base military
housing or a military housing allowance, combat pay, benefits from flexible spending
arrangements (e.g. cafeteria plans), foreign income exclusion or credit for federal tax
on special fuels.
j. Money received or paid on your behalf (e.g., bills), not reported elsewhere on this
form. This includes money that you received from a parent whose financial
information is not reported on this form and that is not part of a legal child support
agreement.
TOTAL
TOTAL
$
$
$
$
$
$
XXXXXX
$
D. Supplemental Nutrition Assistance Program (SNAP)
Please select one of the following statements:
 I received SNAP benefits during 2013 or 2014.
 My parent(s) received SNAP benefits during 2013 or 2014.
 Neither my parents or I received SNAP benefits during 2013 or 2014.
___________________________________________________________________________
Student Name: ____________________________
Student’s ID #: (700)______________
E. Child Support PAID
Do not include support paid for children in your parent(s) household that you included on this form in Section B.
Please select one of the following statements:
 I paid child support in 2014. Provide documentation.
 My parent(s) paid child support in 2014. Provide documentation.
 Neither my parent(s) or I paid child support in 2014.
Name of Person to Whom Child
Support Was Paid:
Name of Child for Whom Support Was Paid:
Amount Paid in
2014:
F. Certification
By signing this worksheet, I (we) certify that all the information reported on all pages of this worksheet is complete and correct. I
(we) understand that if I (we) purposely give false or misleading information, I (we) may be fined, or sentenced to jail, or both.
X __________________________________________________________
Student
X___________________________________________________________
Parent
_____________________________
Date
_____________________________
Date