6729 NW 39th Expressway
Bethany, OK 73008
1-800-648-9899 (405) 491-6310 Fax: (405) 717-6271
Email: finaid@snu.edu
2014-15 V4 Custom Verification Worksheet
Section 1 – Student Information
Last Name
First Name
(Permanent Address) Street & Number
Local Phone Number (Include Area Code)
Social Security Number
Student SNU ID Number
City/State/Zip
Date of Birth
Permanent Phone Number (Include Area Code)
Email Address
Section 2 – High School Completion Status
Attach one of the following documents to certify the student has completed high school (mark the box of the type of document you are
including).
Copy of the student’s high school diploma
Copy of the high school transcript that includes the date the high school diploma was awarded
Copy of one of the recognized equivalents of a high school diploma:
General Educational Development Certificate (GED)
Certificate recognized by the state as an equivalent to a diploma
Academic transcript that shows the successful completion of at least a two-year program acceptable for full credit toward a
bachelor’s degree
Copy of high school completion for homeschooled students:
Transcript or the equivalent, signed by the parent or guardian, that lists the secondary school courses completed by the
applicant and documents the successful completion of a secondary school education
A secondary school completion credential for home school provided for under state law
Section 3 – Identity/Statement of Educational Purpose
IDENTITIY AND STATEMENT OF EDUCATIONAL PURPOSE
(TO BE SIGNED AT INSTITUTION)
The student must appear in person at SOUTHERN NAZARENE UNIVERSITY to verify his or her identity by presenting a valid
government-issued photo identification (ID), such as, but not limited to, a driver’s license, other state-issued ID, or passport. The
institution will maintain a copy of the student’s photo ID that is annotated with the date it was received and the name of the
official at the institution authorized to collect the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the following:
STATEMENT OF EDUCATIONAL PURPOSE
I certify that I _______________________________ am the individual signing this Statement of Educational Purpose and that
(Print name)
the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending
SOUTHERN NAZARENE UNIVERSITY for 2014-2015.
Student Signature
Date
Student’s ID Number
Approved By (Financial Aid Official)
Date
Print Name
G/FAID/2014-2015 Forms/V4 Verification 14-15
OVER
Section 4 – Child Support Paid
Did you (or your parents if you are a dependent student) pay child support in 2012?
YES: Complete the table below
NO
Name of Person to Whom Child Support Was Paid
Name of Child for Whom Support Was Paid
Amount Paid in 2012
PLEASE NOTE: Parents can EITHER include children as members of the household OR include the amount of child support paid. Parents MAY
NOT include the same children as members of the household AND also list child support paid for them. By signing this, you are certifying that
you have not included the same children as members of the household and as children you paid child support for in 2012.
Section 5 – Supplemental Nutrition Assistance Program (Food Stamps)
Did you, your parents, or anyone in your parents’ household receive Supplemental Nutrition Assistance Program (SNAP) benefits in 2011 or
2012?
YES (we may request additional documentation)
NO
Step 6 – Certification
By signing this worksheet, I (we) certify that all of the information reported on this worksheet is complete and accurate. If dependent, at least
one parent must sign. If it appears the information in this document is inaccurate, we may ask for additional information.
WARNING: If you purposely give false or misleading information on the worksheet, you may be fined, be sentenced to jail, or both.
Student Signature
Date
Parent Signature (if DEPENDENT student)/Spouse Signature (if student is MARRIED)
G/FAID/2014-2015 Forms/V4 Verification 14-15
Student Name (Please Print)
Date
SNU Student ID #
Parent OR Spouse Name (Please Print)