Dependent 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
DEPENDENT 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.
INSTRUCTIONS:
Section A:
Please print clearly or type your information.
Section B:
Family Information. List the people in your parents’ household. Include: yourself, your parents you live
with (including stepparent), and your parents’ other children if they are living at home. You should
include other children not living at home if your parents provide more than half of their support from July
1, 2014 through June 30, 2015.
Include children who would be required to provide parental information when applying for Federal Student
Aid, and other people if they now live with your parents, and your parents 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, excluding your parents, will be attending at
least half time during July 1, 2014 through June 30, 2015.
Section C:
Untaxed Income. You and your parents must complete this section to report
subject to federal income tax.
DO NOT INCLUDE: student aid, earned
credit, welfare payments, untaxed Social Security benefits, WIA educational
benefits from flexible spending plans/cafeteria plans, foreign income exclusion or
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 75 on your Student Aid Report.)
Part 2 asks whether your parent PAID child support in 2013.
your Student Aid Report.)
Section E:
sources of income not
income credit, child tax
benefits, combat pay,
credit for federal tax on
(Refer to your answer to question 93b on
Sign, date and return the Dependent 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 DEPENDENT STUDENT VERIFICATION WORKSHEET
A. Student Information:
Last name
(To update your mailing address log in to ozone.ou.edu,)
First name
M.I.
Address (include apt. no.)
City
Social Security Number
OU ID Number
State
Zip Code
Expected OU Graduation Date
B. Family Information: (Refer to questions 73 & 74 on your Student Aid Report and the instructions for this worksheet.)
Full Name
Attach additional sheets if needed to list all household members.
Age
Relationship
Name of college attending in 14-15
Self
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
xxxxxxxxxxxxxxxxxxx
Parents
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
xxxxxxxxxxxxxxxxxxx
Child support RECEIVED for all children. Do not include foster or adoption
payments.
(FAFSA Question 94c parent)
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.
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.
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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 54g student; 94g parent)
Don’t include the value of onbase military housing or the value of a basic military allowance for housing.
Veterans non-education benefits such as Disability, Death Pension, or
Dependency & Indemnity Compensation (DIC) and/or VA Educational WorkStudy allowances.
(FAFSA Question 45h student; 94h parent)
Other untaxed income not reported elsewhere, such as workers’ compensation,
disability, etc. See front instruction page for what NOT to include
(FAFSA
Question 45i student, 94i parent)
xxxxxxxxxxxxxxxxxxxxxx
Money received, or paid on your behalf (e.g. bills), not reported elsewhere on this
form.
(FAFSA Question 45j student)
D. Parent’s Other Information to Be Verified
1. Complete this section if someone in the student’s parent’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 the student’s
school, I will provide documentation of the receipt of SNAP benefits during 2012 and/or 2013.
2. Complete this section if one of the student’s parents paid child support in 2013.
One (or both) of the student’s parents listed in Section B of this worksheet PAID child support in 2013. The parent(s)
should 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 the school, I will provide documentation of the payment of child support. If
you need more space, attach a separate page that includes the student’s 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
Chris Smith (example)
Terry Jones
Amount of Child
Support Paid in
2013
$6,000.00
E. Sign this Worksheet (At least one parent must sign.)
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
Mother/Stepmother’s Signature
Date
Daytime Phone Number (include area code)
Date
Father/Stepfather’s Signature
Date
Return this form to: Office of Financial Aid Services / 1000 Asp Ave., Room 216 Buchanan Hall / Norman, OK 73019-4078
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