Independent Student Verification Worksheet

THE UNIVERSITY OF OKLAHOMA
FINANCIAL AID SERVICES
1000 Asp Avenue, Room 216
Norman, Oklahoma 73019-4078
Phone (405) 325-4521 Fax (405) 325-7608
www.ou.edu/financialaid
2014-2015
UNIVERSITY OF OKLAHOMA
OFFICE OF FINANCIAL AID SERVICES
INDEPENDENT STUDENT VERIFICATION WORKSHEET
Your application was selected for review in a process called "Verification.” By law, we have the right to ask you for this
information before awarding federal aid. If there are differences between your application information and these
documents, we will send corrections electronically to the Department of Education to have your information reprocessed.
If you have questions about completing this worksheet, you may contact O.U. Financial Aid Services at (405) 325-4521.
Section A:
Please print clearly or type your information.
Section B:
Family Information. List the people in your household. Include: yourself, your spouse (if you have one),
and your/your spouse’s children, if you provide more than half of their support from July 1, 2014 through
June 30, 2015. Also include other people if they now live with you and you provide more than half of their
support and will continue to provide more than half of their support from July 1, 2014 through June 30,
2015. Do not include foster children in the household.
Also write in the name of the college any household member will be attending for at least half time during
July 1, 2014 through June 30, 2015.
Section C:
Untaxed Income. You and your spouse must complete this section to report sources of income not
subject to federal income tax.
DO NOT INCLUDE: student aid, earned income credit, child tax credit,
welfare payments, untaxed Social Security benefits, WIA educational benefits, combat pay, benefits from
flexible spending plans/cafeteria plans, foreign income exclusion or credit for federal tax on special fuels
Section D:
Part 1 asks whether anyone in the household received benefits from the Supplemental Nutrition
Assistance Program (SNAP, formerly known as food stamps) at any time during the 2012 OR 2013
calendar year. (Refer to your answer to question number 97 on your Student Aid Report.)
Part 2 asks whether you or your spouse PAID child support in 2013 because of divorce or separation or
as a result of a legal requirement. Don’t include support for children in your household, as reported in
question 93 on your Student Aid Report. (Refer to your answer to question 44b on your Student Aid
Report.)
Section E:
Sign, date and return the Independent Student Verification Worksheet to the OU Office of Financial Aid
Services. Keep these instructions and copies of everything you send to the financial aid office.
Complete the next two pages as instructed and return them to Financial Aid Services.
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THE UNIVERSITY OF OKLAHOMA
FINANCIAL AID SERVICES
1000 Asp Avenue, Room 216
Norman, Oklahoma 73019-4078
Phone (405) 325-4521 Fax (405) 325-7608
www.ou.edu/financialaid
2014-2015 INDEPENDENT STUDENT VERIFICATION WORKSHEET
A. Student Information: (To update your mailing address log in to ozone.ou.edu,)
Last name
First name
M.I.
Address (include apt. no.)
City
Social Security Number
Sooner ID Number
State
Zip Code
Expected OU Graduation Date
B. Family Information: (Refer to questions 95 & 96 on your Student Aid Report and the instructions for this worksheet.)
Attach additional sheets if needed to list all household members.
Full Name
Age
Relationship
Self
Name of college attending in 14-15
University of Oklahoma
C. Untaxed income: Do not leave any item blank. Enter “zero” for any item you did not receive.
Please report the TOTAL amount received during the year 2013.
Student
Spouse
Payments to tax-deferred pension and savings plans (paid directly or withheld
from earnings), including, but not limited to, amounts reported on the W-2 forms
in Boxes 12a through 12d, codes D, E, F, G, H and S. DON’T INCLUDE
AMOUNTS REPORTED IN CODE DD (contributions toward health benefits.)
IRA deductions and payments to self-employed SEP, SIMPLE, Keogh and other
qualified plans from IRS Form 1040 – line 28 + line 32 OR 1040A – Line 17
Child support received for all children. Do not include foster or adoption
payments.
(FAFSA Question 45c)
Tax exempt interest income from IRS Form 1040 - line 8b or 1040A line 8b
Untaxed portions of IRA distributions from IRS Form 1040 - lines (15a minus 15b)
or 1040A—lines (11a minus 11b). Exclude rollovers. If negative, enter a zero
here.
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Untaxed portions of pensions from IRS Form 1040 - lines (16a minus 16b) or
1040A - lines (12a minus 12b). Exclude rollovers. If negative, enter a zero here.
Money received, or paid on your behalf (e.g. bills), not reported elsewhere on this
form.
(FAFSA Question 45j)
Housing, food and other living allowances paid to members of the military, clergy
and others (including cash payments and cash value of benefits.
(FAFSA
Question 45g student)
Veterans non-education benefits such as Disability, Death Pension, or
Dependency & Indemnity Compensation (DIC) and/or VA Educational WorkStudy allowances.
(FAFSA Question 45h student)
Other untaxed income not reported elsewhere, such as workers’ compensation,
disability, etc. See front instruction page for what NOT to include
(FAFSA
Question 45i)
D. Independent Student’s Other Information to Be Verified
1. Complete this section if someone in the student’s household (listed in Section B) received benefits from the
Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2012
or 2013 calendar years.
One of the persons listed in Section B of this worksheet received SNAP benefits in 2012 or 2013. If asked by
my school, I will provide documentation of the receipt of SNAP benefits during 2012 and/or 2013.
2. Complete this section if you or your spouse, if married, paid child support in 2013.
If either I, or if married my spouse who is listed in Section B of this worksheet, paid child support in 2013
indicate below the name of the person who paid the child support, the name of the person to whom the child
support was paid, the names of the children for whom child support was paid, and the total annual amount of
child support that was paid in 2013 for each child. If asked by my school, I will provide documentation of the
payment of child support. If you need more space, attach a separate page that includes your name and OU ID
Number at the top.
Name of Person Who Paid
Child Support
Name of Person to Whom
Child Support was Paid
Name of Child for Whom
Support Was Paid
Marty Jones(example)
Chris Smith
Terry Jones
Amount of Child
Support Paid in
2013
$6,000.00
E. Sign this Worksheet
By signing this worksheet, I (we) certify that all the information reported to qualify for Federal student aid is complete and correct to the
best of our knowledge. I understand I may be required to submit additional documentation to resolve missing, conflicting or discrepant
information. If I purposely give false or misleading information on this worksheet I may be fined, be sentenced to jail, or both.
Student’s Signature
Date
Spouse’s Signature
Date
Return this completed form to: OU FINANCIAL AID SERVICES, 1000 Asp Avenue, Room 216, Norman, OK 73019-4078
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