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33 views3 pages

ESignDocument 1

Uploaded by

mihaljevichmark4
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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2024-2025

Academic Year

Independent Verification Worksheet


Student’s Name: _____________________
CHARLETTE CARPENTER Student ID:_________
2674286

Your Free Application for Federal Student Aid (FAFSA) was selected for a process called verification. Please answer the
following questions to verify information reported on your FAFSA, then electronically sign the document by pressing
‘Sign’ and submit the form by clicking ‘Finish’.
MARITAL STATUS

What was your marital status as of the date you filed your FAFSA?
 Single (Never Married)  Divorced
 Married (Not Separated)  Separated
 Remarried  Widowed

Extended family members or other individuals (such as your adult siblings, nieces, nephews, etc.) may be included only if
they live with you AND receive more than half their support from you during the school year. Extended family members
should not be listed in the family size if they are:

• Working/employed/self-employed
• Receiving means-tested benefits (SNAP, TANF, WIC, subsidized housing, etc.)
• Receiving pensions/retirement
• Receive Social Security Income or Disability payments

To claim you support an individual who is receiving any of the benefits listed above, your total financial support must
exceed the amount they receive from these sources. Please consider these sources of income carefully before
claiming that you support extended family members or other individuals more than 50%.

FAMILY SIZE

List the people in your household, including:


• Yourself (and your spouse, if applicable).
• Your children only if you and/or your spouse will provide more than half of their support from July 1, 2024 through
June 30, 2025.
• Other people if they now live with you AND you or your spouse provided more than half of their support and will
continue to provide more than half of their support from July 1, 2024 through June 30, 2025.
• DO NOT INCLUDE ANY UNBORN CHILDREN IN THE FAMILY SIZE.

Name of Family Member Relationship to Student Date of Birth Email Address


CHARLETTE CARPENTER Self 05/16/1985

Check here if more space is needed and you would like to add an attachment.
Student 2022 Income Information
Were you a resident of the United States in 2022? Yes No

I filed a 2022 Tax Return.


If married or remarried, did you file your 2022 federal tax returns jointly with your spouse? Yes No
OR
Complete this section if you DID NOT file a 2022 Tax Return.
I, __________________
CHARLETTECARPENTER am not required to file a 2022 Tax Return.
Student’s Name

Did you have any earnings, other income, or receive any resources that supported you during the 2022 tax
year?
Yes No
If so, please list all sources and dollar amounts below.

Employer’s Name or other source Total Amount received in W2 Issued?


2022
U.S. $ Yes No
U.S. $ Yes No
U.S. $ Yes No
U.S. $ Yes No
U.S. $ Yes No

Spouse 2022 Income Information


Spouse’s SSN: ___________
Was your spouse a resident of the United States in 2022? Yes No
My spouse filed a 2022 Tax Return.
OR
Complete this section if you DID NOT file a 2022 Tax Return.
My Spouse, __________________ was not required to file a 2022 Tax Return. (complete if applicable)
Spouse’s Name

Did your spouse have any earnings, other income, or receive any resources that supported your spouse during
the 2022 tax year?
Yes No
If so, please list all sources and dollar amounts below.
Employer’s Name or other source Total Amount received in W2 Issued?
2022
U.S. $ Yes No
U.S. $ Yes No
U.S. $ Yes No
U.S. $ Yes No
U.S. $ Yes No

FTPTransferComplete
4
247
Independent
2025
1-18661-2408544-PROD
INDVER25 Verification Worksheet
CERTIFICATION
By signing below, I acknowledge and confirm that the above information is complete and correct. Purposely giving false
or misleading information may result in federal fines, jail sentence, or both.

_____________________________________
07/03/2024
Student Date

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