M ___________________

Office of Student Financial Aid

Germantown Rockville Takoma Park/Silver Spring
Phone: 240-567-5100

Office use only

Code: DEPVWO / VERIFY D ODD

FinancialAid@montgomerycollege.edu

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2012-2013 Dependent Verification Worksheet

SECTION A: STUDENT INFORMATION

Name:

MC ID:

Your 20122013 Free 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 and your parents reported on your FAFSA. To verify that you provided
correct information the MC financial aid office 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 and at least one parent must complete and sign this worksheet, attach
any required documents, and submit this form and other required documents to the financial aid office. We may ask for additional information. If you
have questions about verification, contact us as soon as possible so that your financial aid will not be delayed.

We cannot process your financial aid until all documents are received.
SECTION B: HOUSEHOLD INFORMATION
List yourself (the student) below, even if you do not live with your parents.
Your Name
Age

List your parent(s) below: If your parents are separated or divorced, include only the parent whose information you
were required to provide on the FAFSA. If the parent you list has married or remarried and you have a stepparent,
you must include information about your stepparent.
Parent(s) Name(s)
Age
Relation to Student

List your parent(s) other children if your parent(s) will provide more than half of their support from July 1, 2012,
through June 30, 2013, or if the other children would be required to provide parental information if they were
completing a FAFSA for 20122013. Include children who meet either of these standards, even if they do not live
with your parent(s).
Include other people only if they now live with your parent(s) and get more than half of their support from your
parent(s), AND will continue to get this support from July 1, 2012 through June 30, 2013.
Write in the name of the college for those who will be attending college at least half-time between July 1, 2012 and
June 30, 2013, and will be in a degree or certificate program. If you need more space, attach a separate page.

Other Dependent(s) First & Last Name(s)

Age

Relation to Student

Name of College(if enrolled)

Will be at Least Time

(yes or no)

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Be sure to complete both pages of this form.

2012 - 2013 Dependent Verification Worksheet

SECTION C-1: CHILD SUPPORT PAID (CHECK ONE BOX)
Child Support is defined as monies paid for the care of a minor child (18 and under) to the person who has custody of the
child.
My parent(s) did not pay child support in 2011.
One(or both) parents listed in Section B did pay
Please go to Section D.
child support in 2011. Please go to Section C-2.

SECTION C-2: CHILD SUPPORT

This section should ONLY be filled out if one or both parents paid child support for children living in another household. NOT
for children living in their household. If requested I will provide documentation of the payment of child support.
Name of Person Who Paid
Child Support

Name of Person to Whom Child

Support was Paid

Name of Child for Whom

Support was Paid

Amount of Child
Support Paid in 2011

If more space is needed attach an additional sheet and provide the same information requested above.
If your name is listed in the first column above please sign below.
Mother:
Father:

SECTION D: FOOD STAMP (SNAP) BENEFITS

One or more of the persons in my parents household (listed in section B) received benefits from the
Supplemental Nutrition Assistance Program or SNAP (formerly known as Food Stamps) at some time
during the 2010 or 2011 calendar years. (Attach completed SNAP Program Confirmation Form)
No one in my parents household (listed in section B) received benefits from the Supplemental Nutrition
Assistance Program or SNAP (formerly known as Food Stamps) at some time during the 2010 or 2011
calendar years.

SECTION E: CERTIFICATION
Each person signing this worksheet certifies that all the information reported is complete and correct. At least one parent
must sign.
____________________________________________
Student
Date

____________________________________________
Parent (Stepparent)
Date

WARNING:
If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
All documents requested must be complete and submitted together by mail, or in person or by e-mail attachment. Do not fax this
document. Incomplete forms will delay the processing of your financial aid.

Be sure to complete both pages of this form.

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