2015-2016 Verification Worksheet Independent Student Your application was selected by the U.S. Dept. of Education for review in a process called "verification". In this process, we are required by federal law (34 CFR, Part 668) to compare the information from your application with the information provided on this form and with a transcript of your 2014 federal tax forms (and your spouse's if you are married). If there are differences between your application and the documents you've submitted, corrections may be needed. We cannot process your financial aid until verification has been completed; please provide the required documents within 15 days of starting school or the start of your next academic year as applicable. A. Independent Student’s Information ______________________________________________________________ Student’s Last Name Student’s First Name Student’s M.I. _______________________________________ Student’s ID Number ______________________________________________________________ Student’s Street Address (include apt. no.) _______________________________________ Student’s Date of Birth ______________________________________________________________ City State Zip Code _______________________________________ Student’s Email Address ______________________________________________________________ Student’s Home Phone Number (include area code) _______________________________________ Student’s Alternate or Cell Phone Number B. Independent Student’s Family Information List the people in your household, include: (a) yourself and your spouse, (b) your children, if you will provide more than half of their support from July 1, 2015 through June 30, 2016; and any other people if they now live with you, and you provide more than half of their support and will continue to do so from July 1, 2015 through June 30, 2016. Write the names of all household members; including yourself!: Write in the name of the college for any family member who will be going to college at least half-time from July 1, 2015 through June 30, 2016 and will be enrolled in a degree, diploma or certificate program. Attach a separate page for additional names. We may require additional documentation if we have reason to believe this information is incorrect. Full Name Missy Jones (example) Age Relationship College 18 Sister Self Central University Will be Enrolled at Least Half Time Yes F. Verification of High School Completion Status A component of your verification requires that Uconn School of Social Work confirm that you have completed high school. Please provide one of the following documents confirming that you have completed high school. If you have not yet completed high school, but will complete high school before you begin Uconn School of Social Work, only return this form after you have completed high school. Check one: Attached is a copy of my high school diploma Attached is a copy of my final official high school transcript, showing the date that my high school diploma was awarded. Attached is a copy of my General Education Development (GED) certificate or GED transcript. Attached is an academic transcript indicating that I successfully completed at least a two-year program that is acceptable for full credit toward a bachelor’s degree. I was homeschooled and my state law requires a student to obtain a secondary school completion credential. Attached is a copy of that credential. I was homeschooled and my state law does not require a homeschooled student to obtain a secondary school completion credential. Attached is a transcript or the equivalent, signed by my parent or guardian, that lists the secondary schools courses I completed and documents the successful completion of a secondary school education in a homeschooled setting. G. Certification and Signatures Each person signing this worksheet certifies that all of the information reported on it is complete and correct. The student must sign and date. 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 _________________________________ Date _________________________________________________ Spouse’s Signature _________________________________ Date Return this form to: University of Connecticut- School of Social Work- Financial Aid Office 1798 Asylum Avenue West Hartford, CT 06117 Fax: 860-570-9052 Email: [email protected]