Verification Worksheet – Independent Student
2015-16
Your 2015-16 Free Application for Federal Student Aid (FAFSA) has been selected for review in a process called “Verification”. In this process, MSU will
compare the information you provided on your FAFSA with the financial documents listed on the Verification Letter. If there are discrepancies,
corrections will be made and your financial aid award may be adjusted.
The verification process may take SEVERAL WEEKS and your federal financial aid cannot be disbursed until the process is complete. Therefore, we
suggest that you submit all information to the address on the reverse side of this form WITHIN 30 DAYS. Incomplete paperwork will be returned to
you, thereby delaying the processing of your financial aid. Thank you for your cooperation and prompt response.
Section A - Student Information
________________________________________________________________________
Last name
First name
M.I.
_________________________________________
Student ID# or Social Security Number
________________________________________________________________________
Current Address
___________________________________________
Home Phone#
Cell Phone #
________________________________________________________________________
City
State
Zip Code
___________________________________________
Date of Birth
E-mail Address
Section B - Family Information
IMPORTANT! Please carefully read numbers 1-5 below to ensure you properly complete the Family Information Box at the bottom of this page.
If you need more space please attach a separate page.
1. Student – Write your name and age on the first line.
2.
List the name and age of your spouse, if married. Include your spouse’s information if you were married prior to filling out the FAFSA.
3.
List your children/step-children on the remaining lines, if you will provide more than 50% of their support from July 1, 2015 through June 30,
2016 OR if the children would be required to provide parental information when applying for federal student aid in the Family Information
Box below.
4.
List other people (grandparent, grandchild or cousin) only if they now live with you and you provide more than 50% of their support and will
continue to provide the support from July 1, 2015 to June 30, 2016.
5.
Write in the name of the college for any degree-seeking household member listed in Section B that will be attending at least half time
between July 1, 2015 and June 30, 2016. If you need more space, attach a separate page. Do not indicate that your children are attending
college if they are in high school and taking college courses.
FAMILY INFORMATION BOX
NAME
AGE
RELATIONSHIP TO STUDENT
NAME OF COLLEGE ATTENDING *
Student/Self
MSU
-OVER-
Section C – Complete this section if you did not file a Tax Return
If you and your spouse, if married, earned income by working in 2014 but did not file a tax return and were not required to file a tax return, list below
your employer(s) and any income received in 2014 (use the W-2 form or other earnings statements).
Name of Employer/Source of Income
Student 2014 Earnings
Spouse 2014 Earnings
$
$
$
$
$
$
❑Student
Please check the box if you had zero income:
❑ Spouse
If a box was checked above for Student or Spouse, attach a written statement explaining the means of 2014 financial support for the people listed in
your household.
Section D - 2014 Child Support Paid
Did any of the persons listed in Section B of this worksheet PAY child support in 2014? ❑Yes ❑ No
If yes, complete the information below.
Name of Person Who Paid
Child Support
Example:
John Doe
Name of Person
to Whom
Child Support was Paid
Jane Doe
Name of Child
for Whom Support
Was Paid
Tim Doe
Total Amount of
Child Support Paid
for 2014
$1800
$
$
$
FOOD STAMPS
Did any of the persons listed in Section B of this worksheet receive Supplemental Nutrition Assistance Program (SNAP) or food stamp benefits in 2013
or 2014? ❑Yes ❑ No
If yes, write the name of household member who received the benefits _______________________________________________________________
FEDERAL WORK-STUDY FUNDS
Did you earn Federal Work-Study funds in 2014?
❑Yes ❑ No
You must submit a copy of your W-2(s) for these earnings.
If yes, total amount earned in 2014.
$___________
❑Yes ❑ No Are you or your spouse currently serving in the U.S. Armed Forces or are a National Guard or Reserves enlistee who is on active duty for
other than state or training purposes. (Answer “No” if you are a National Guard or Reserves enlistee who is on active duty for state or training
purposes).
Section E - Signatures
The information provided on this form is true and complete to the best of my knowledge. I understand that purposely giving false or misleading
information I may be fined up to $20,000, sent to prison, or both.
Student’s Signature ________________________________________________
Date ______/______/______
Please make sure this worksheet is completely filled out, signed and ALL documents requested are included.
Forms can be mailed, emailed, faxed or dropped off at the address listed.
Minot State University, Financial Aid Office, 500 University Ave W, Minot ND 58707
Phone: 1-800-777-0750 or 701-858-3586 Fax: 701-858-4310
E-mail: Amanda.Isham@minotstateu.edu
Campus address: 202 Ceres Hall or 176 Memorial Union (Bison Connection)
Phone: 1-866-924-8969 or (701) 231-8398 ▪ E-mail for questions: Mary.Gerardy@ndsu.edu
Revised: 6/2012