PLEASE COMPLETE AND RETURN

OFFICE OF FINANCIAL AID

278 WHITES BRIDGE ROAD
STANDISH, ME 04084
www.sjcme.edu/finaid

FAX
TEL

207.893.6699
800.752.1266
207.893.6612
EMAIL finaid@sjcme.edu

2015-2016 VERIFICATION WORKSHEET

Please complete all sections of this form for the 2015-16 academic year. This form is required for financial aid
consideration for any semester or course(s) beginning between June 1, 2015 and May 31, 2016. The College will be
comparing the information on this form with the information you provided on the FAFSA. You may be asked to verify
additional items at a later date.

1. Student Information
Name______________________________________

SS# ______________________________

Address_____________________________________________ DOB_______________________
Daytime Phone____________________________ E-Mail ________________________________

2. Untaxed Income Received and Child Support Paid Questions

a.

Did you or anyone in your household receive Supplemental Nutrition Assistance (formerly known as Food
Stamps) in 2013 or 2014? Yes ____ No ____
b. Did you, your spouse (if you are married) or your parent(s) (if you are a dependent) receive any untaxed income
in 2014? Yes ___ No ___. If yes, please provide the information requested in this table:
Type of Untaxed Income

c.

Name of Person Who Received

the Untaxed Income

Total Amount Received in 2014

Did you, your spouse (if you are married) or your parent(s) (if you are dependent) pay any child support in
2014? Yes ____ No ____ If yes, please provide the information requested in this table:
Annual Amount Paid

Name of the Person Who

Paid the Support

Name of the Person to

Whom the Support Was
Paid

Names of Child for

Whom Child Support Was
Paid

PLEASE TURN OVER

PLEASE COMPLETE AND RETURN

1. Family Information Confirm all of the household members that you reported on the FAFSA by
completing the chart below. See the definitions provided which explain who can be included in the
household for a dependent student or for an independent student. Only the parent(s) reported on
the FAFSA should be included.
Are you a DEPENDENT Student? You were born on or after January 1, 1991, are unmarried, are an
undergraduate and are without dependents. List all the people in your parents household, including:
Yourself (even if you dont live with your parent),
Your parent(s) including stepparent, if your custodial parent is remarried,
Your parents children and stepchildren, if parent(s) provides more than half their support,
Other people if they now live in your parents household and parent(s) are providing and will continue to
provide more than half of their support from July 1, 2015 through June 30, 2016.
Or are you an INDEPENDENT Student? You were born prior to January 1, 1991, are married, are a graduate
student, have qualifying dependents, are homeless, are an orphan, are/were in foster care, legal guardianship or
are/were a ward of the court. List all the people in your household, including:
Student and students spouse,
Children, if student provides more than half their support, and
Other people if they now live in your household and student will provide more than half their support from July
1, 2015 through June 30, 2016.
Based on the definitions above, complete the following chart:
NAME

SJC Students Name:

2.

AGE

RELATIONSHIP
TO STUDENT

NAME OF COLLEGE IF ATTENDING IN

2015-16 (must be enrolled at least
half-time in a degree or certificate
program)

Self

Saint Josephs College

YEAR IN COLLEGE
(e.g.,
Sophomore)

I/We attest that the information on this worksheet is complete and correct. You may be asked to provide
additional documentation of your responses. If student is dependent at least one parent must sign. Warning:
If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or
both.

STUDENTS SIGNATURE _______________________________

DATE ____________

PARENTS SIGNATURE ________________________________

(Dependent students only)

DATE ____________