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2015–2016 Verification Worksheet
Your Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. Federal Law
requires that before receiving Federal Student Aid we need to confirm the information reported on your FAFSA. The
Financial Aid Office will compare your FAFSA information with this worksheet and other required documents. If there are
differences, your FAFSA information may be corrected and your financial aid could change.
This Verification Worksheet must be submitted within two weeks of receipt of the request.
Failure to submit these documents could result in cancellation of your financial aid awards.
Definitions:
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If you completed the FAFSA listing your parent(s) income information and they had to sign your FAFSA form, you
are considered a dependent student. Your parental data is also required for completion of this form.
Please see our How FAFSA Defines a Parent worksheet if you need assistance in determining who is considered a
parent. (Available on our website at admission.hartford.edu/finaid/)
If you completed the FAFSA and did not have to provide your parent(s) income information, and they did not have
to sign your FAFSA, you are considered an independent student. Your parental data is not needed for completion of
this form.
A. Student Information – Please provide only the student’s information for this section.
Name_________________________________________________________________________ID #_________________________________________
Address______________________________________________________________________Date of Birth _______________________________
City ___________________________________State _________ Zip Code _______________Phone ___________________________________
B. Student’s Family Information
List below the people in your household or your parent(s) household. Include:
• yourself,
• if married, your spouse
• your parent(s) if you live with them (including step-parent)
• your parent(s) other children (only if you or your parents will provide more than half of their support
from 7/1/2015 through 6/30/2016)
• other people if they now live with you or your parent(s) AND you or your parent(s) will provide more than
half of their support from 7/1/2015 through 6/30/2016
• also include the college for any household member, excluding your parent(s), who will be attending
college at least six credits per semester between July 1, 2015 and June 30, 2016, AND will be enrolled in a
degree, diploma, or certificate program
Write the names below of all household members that comply with the above guidelines.
Full Name
Age
Relationship
Yourself
College Attending
University of Hartford
C. SNAP (Food Stamp) Verification
Student ID #_____________________________
Has anyone in the household received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly
known as food stamps) any time during the 2013 or 2014 Calendar Years?
Yes
No
Required For 2014 Tax Filers (student and/or parents):
If you filed in 2014, the IRS Data Match or Tax Return Transcript is required for your file.
Please refer to the Office of Student Financial Assistance’s website at admission.hartford.edu/finaid/.
Instructions can be found under the Forms section labeled as Tax Return Transcript vs Data Match.
Please proceed to required Part F.
For 2014 Non-Tax Filers (student and/or parents) Part D, E, and F are required.
D. Parent Non-Filing Income Statement
Name of parent that did not file: _______________________________________________________________________________
Check the boxes that apply:
The parent was not employed and had no income earned from work in 2014.
The parent was employed in 2014 and has attached an IRS W-2 form from each employer.
The parent was employed in 2014 was not issued an IRS W-2 form; therefore, we have completed the chart
below. (If additional lines are needed, please attach a signed separate page with worksheet.)
Employer’s Name
2014 Amount Earned
E. Student Non-Filing Income Statement
Check the boxes that apply:
The student or spouse was not employed and had no income earned from work in 2014.
The student or spouse was employed in 2014 and has attached an IRS W-2 form from each employer.
The student or spouse was employed in 2014 was not issued an IRS W-2 form; therefore, we have
completed the chart below. (If additional lines are needed, please attach a signed separate page with worksheet.)
Employer’s Name
2014 Amount Earned
F. CERTIFICATION AND SIGNATURE
By signing this worksheet, I (we) certify that all of the information reported on this worksheet is complete and
correct. If the student is a dependent, at least one parent must sign.
Warning: If you purposely give false or misleading information on this form, you may be fined, be sentenced to jail, or both.
Student Signature _________________________________________________________ Date_______________
Parent Signature* __________________________________________________________ Date_______________
*Required if a dependent student
You will be unable to save changes to this document. Please print a copy for your records.