2016-2017 Verification Worksheet Independent (V4)

VERIFICATION WORKSHEET INDEPENDENT (V4)
2016-2017
Your 2016-2017Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says
that before awarding Federal Student Aid, we may ask you to confirm the information you reported on your FAFSA. To verify that you
provided correct information the financial aid administrator at your school will compare your FAFSA with the information on this
worksheet and with any other required documents. If there are differences, your FAFSA information may need to be corrected. You must
complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the financial aid
administrator at your school. Your school may ask for additional information. If you have questions about verification, contact your
financial aid administrator as soon as possible so that your financial aid will not be delayed.
A. Independent Student’s Information
Student’s Last Name
Student’s First Name
Student’s M.I
Student’s Street Address (include apt. no.)
City
State
Student’s Social Security Number
Student’s Date of Birth
Zip Code
Student’s Home Phone Number (include area code)
Student’s Email Address
Student’s Alternate or Cell Phone Number
B. Independent Student’s High School Completion Status to Be Verified
Provide one of the following documents to indicate the student’s high school completion status when the student begins
college in 2016-2017.:

A copy of the student’s high school diploma.

For students who completed secondary education in a foreign country, a copy of the “secondary school leaving
certificate” or other similar document.

A copy of the student’s final official high school transcript that shows the date when the diploma was awarded.

A state certificate or transcript received by a student after the student passed a State-authorized examination that the
State recognizes as the equivalent of a high school diploma (GED test, HiSET, TASC, or other State-authorized
examination).

An academic transcript that indicates the student successfully completed at least a two-year program that is acceptable
for full credit toward a bachelor’s degree.

For a student who was homeschooled in a state where state law requires the student to obtain a secondary school
completion credential for homeschooling (other than a high school diploma or its recognized equivalent), a copy of
that credential.

For a student who was homeschooled in a state where state law does not require the student to obtain a secondary
school completion credential for homeschooling (other than a high school diploma or its recognized equivalent), a
transcript, or the equivalent, signed by the student's parent or guardian, that lists the secondary school courses the
student completed and includes a statement that the student successfully completed a secondary school education in a
homeschool setting.
Page 1 of 5
FA-F-0036
21-May-15,
07-Mar-16, Rev. B
C
VERIFICATION WORKSHEET INDEPENDENT (V4)
1.
I graduated from
2.
Check here if a copy of your high school diploma or final official high school transcript, which includes your
completion/graduation date, is attached to this worksheet.
I successfully completed the General Education Diploma (GED) requirements:
3.
Check here if a copy of your General Educational Development (GED) certificate, an official GED transcript
that indicates you passed the exam, or a state authorized high school equivalent certificate, is attached to this
worksheet.
I was home-schooled by
:
4.
5.
High School located in
:
Check here if a transcript or the equivalent signed by your parent or guardian that lists the secondary school
courses you completed and documents that you successfully completed secondary school education in a home
school setting, is attached to this worksheet.
I have successfully completed at least a two-year degree program that is acceptable for full credit towards a bachelor’s
degree:
Check here if an official copy of your academic transcript showing that you completed a least a two-year program
acceptable for full credit towards a bachelor’s degree is attached to his worksheet.
I graduated from
High School located in
, a foreign country:
Check here if a copy of your “secondary school leaving certificate” or other similar document, which includes
your completion status date, is attached to this worksheet.
C. Independent Student’s Child Support Paid to Be Verified
Complete this section if you or your spouse, if married, paid child support in 2015.
The students or spouse, who is a member of the student’s household, paid support in 2015. List below the names of the
persons who paid the child support, the names of the persons to whom the child support was paid, the names of the
children for whom child support was paid, and the total annual amount of child support that was paid in 2015 for each
child.
If more space is needed, provide a separate page that includes your name and Social Security Number at the top.
Name of Person Who Paid
Child Support
Name of Person to Whom Child
Support was Paid
Name and Age of Child for
Whom Support Was Paid
Marty Jones(example)
Chris Smith
Terry Jones
Amount of Child
Support Paid in
2015
$6,000.00
Note: If we have reason to believe that the information regarding child support paid is not accurate, we may require additional
documentation, such as:

A copy of the separation agreement or divorce decree that shows the amount of child support to be provided;

A signed statement from the individual receiving the child support certifying the amount of child support received; or
Page 2 of 5
FA-F-0036
21-May-15,
07-Mar-16, Rev. B
C
VERIFICATION WORKSHEET INDEPENDENT (V4)

Copies of the child support payment checks, money order receipts, or similar records of electronic payments having been
made.
D. Independent Student’s SNAP Program to Be Verified
Complete this section if someone in the student’s household received benefits from the Supplemental Nutrition Assistance
Program or SNAP (formerly known as food stamps) any time during the 2014 or 2015 calendar years.
The student certifies that
, a member of the student’s household, received SNAP
(formerly known as the Food Stamp Program) sometime during 2014 or 2015. If asked by my school, I will provide
documentation of the receipt of SNAP benefits during 2014 and/or 2015.
The student’s household includes:

The student.

The student’s spouse, if the student is married.

The student’s or spouse’s children if the student or spouse will provide more than half of the children’s support
from July 1, 2016, through June 30, 2017, even if the children do not live with the student.

Other people if they now live with the student and the student or spouse provides more than half of the other
people’s support and will continue to provide more than half of their support through June 30, 2017.
E. Identity/Statement of Educational Purpose to Be Verified (To Be Signed at the Institution)
The student must appear in person at
Metro Technology Centers
to verify his or her
(Name of Postsecondary Educational Institution)
identity by presenting an unexpired 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
by the institution with the date it was received and reviewed 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 English or Spanish statement:
Statement of Educational Purpose
I certify that I _____________________________ am the individual signing this
(Print Student’s Name)
Statement of Educational Purpose and that the Federal student financial assistance
I may receive will only be used for educational purposes and to pay the cost of attending
Metro Technology Centers
for 2016-2017.
(Name of Postsecondary Educational Institution)
_________________________________________
(Student’s Signature)
_______________
(Date)
______________________
(Student’s ID Number)
Page 3 of 5
FA-F-0036
21-May-15,
07-Mar-16, Rev. B
C
VERIFICATION WORKSHEET INDEPENDENT (V4)
Declaración de Propósito Educativo
Certifico que yo, __________________________, soy el individuo que firma esta
[Imprimir Nombre del Estudiante]
Declaración de Finalidad Educativa y que la ayuda financiera federal estudiantil que yo pueda
recibir, sólo será utilizada para fines educativos y para pagar el costo de asistir a
____________________________________ para 2016-2017.
[Imprimir Nombre de Institución Educativa Postsecundaria]
_____________________________________________
[Firma del Estudiante]
________________
[la Fecha]
________________________________
[Número de Identificación del Estudiante]
F. Identity/Statement of Educational Purpose to Be Verified (To Be Signed With Notary)
If the student is unable to appear in person at
Metro Technology Centers
s
(Name of Postsecondary Educational Institution)
to verify his or her identity, the student must provide:
(a) A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged in the notary statement
below,
such as, but not limited to a driver’s license, other state-issued ID, or passport; and
(b) The original notarized Statement of Educational Purpose (in English or Spanish) provided below, which muct be notarized.
If the notary statement appears on a separate page that the Statement of Educational Purpose, there must be clear indication that
the Statement of Educational Purpose was the document notarized.
Statement of Educational Purpose
I certify that I _____________________________ am the individual signing this
(Print Student’s Name)
Statement of Educational Purpose and that the federal student financial assistance I may receive will
only be used for educational purposes and to pay the cost of attending
Metro Technology Centers
for 2016-2017.
(Name of Postsecondary Educational Institution)
_________________________________________
(Student’s Signature)
_______________
(Date)
______________________
(Student’s ID Number)
Page 4 of 5
FA-F-0036
21-May-15,
07-Mar-16, Rev. B
C
VERIFICATION WORKSHEET INDEPENDENT (V4)
Declaración de Propósito Educativo
Certifico que yo, __________________________, soy el individuo que firma esta
[Imprimir Nombre del Estudiante]
Declaración de Finalidad Educativa y que la ayuda financiera federal estudiantil que yo pueda
recibir, sólo será utilizada para fines educativos y para pagar el costo de asistir a
____________________________________ para 2016-2017.
[Imprimir Nombre de Institución Educativa Postsecundaria]
_____________________________________________
[Firma del Estudiante]
________________
[la Fecha]
________________________________
[Número de Identificación del Estudiante]
Notary’s Certificate of Acknowledgement
State of ________________________________________________________________________
City/County of ___________________________________________________________________
On_____________________, before me, ____________________________________________,
(Date)
(Notary’s name)
personally appeared, ____________________________________________, and proved to me
(Printed name of signer)
on basis of satisfactory evidence of identification _______________________________________
(Type of government-issued photo ID provided)
to be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal
(seal)
________________________________________
(Notary signature)
My commission expires on _________________________
(Date)
G. Worksheet Certification and Signature
Each person signing below certifies that all of the
information reported is complete and correct. The student
must sign this worksheet. If married, the spouse’s signature
is optional.
WARNING: If you purposely give false or misleading
information on this worksheet, you may be fined, be
sentenced to jail, or both.
_________________________________________________
Student’s Signature (Required)
_________________________________
Date
_________________________________________________
Spouse’s Signature (Optional)
_________________________________
Date
Submit this worksheet to the Metro Technology Centers Financial Aid Office
1900 Springlake Drive, Oklahoma City, OK, 73111
Page 5 of 5
FA-F-0036
21-May-15,
07-Mar-16, Rev. B
C