1314_COMBO Verification Worksheet - Providence College

2013-2014
Providence College
Office of Financial Aid
COMBO Verification Worksheet
Office Use Only:
First Name:___________________ # of pages:_________ Track Req:_VCOMBO_
Last Name: :__________________ Current Status:_______ Prep by:____________
BID:________________________
Prior Status:_________ Date Prep:__________
COMBO VERIFICATION WORKSHEET
Student Name: ____________________ Banner ID: ___________________ Date: ___________________
A. IMPORTANT INFORMATION
Based upon information reported to the U.S Department of Education through the Free Application for Federal
Student Aid (FAFSA), the College is required to verify information specific to you and your family.
B. SNAP
Your FAFSA indicates that you (or someone) in your household*, reported that they benefit from the
Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) during the 2011 or
2012 calendar years. SNAP may be known by another name in some states. For assistance in determining the
name used in a state, please call 1-800-4FED-AID. Please check NO or YES in the boxes below. Do not leave
this section blank. *Household for a dependent student includes: student, parents, siblings or other persons (if
the parents provide more than half their support). Household for an independent student includes: student,
spouse (if married), student’s or spouses’ children or other persons (if the student or spouse will provide more
than half their support).
NO
None of the persons listed as a member in my household on the FAFSA received SNAP
benefits in 2011 or 2012.
YES
Yes, one of the persons listed as a member in my household on the FAFSA received
SNAP benefits in 2011 or 2012. If asked, I will provide documentation of the receipt of
SNAP benefits during 2011 or 2012.
C. CHILD SUPPORT PAID
Your FAFSA indicated that someone in your household paid child support in 2012. This could include one of
your parents (if applicable), your spouse (if applicable) or you (the student). Please confirm this information by
checking NO or YES in the boxes provided below. Do not leave this section blank.
NO No, no one included in the household on my FAFSA paid child support in 2012.
YES
Yes, someone included in the household on my FAFSA paid child support during 2012. I
have completed the grid (see reverse) detailing these payments. If asked, I will provide
documentation that could include the following: copy of separation agreement or divorcee

decree that shows the amount of the child support to be provided, a statement from the
individual receiving the child support certifying the amount of child support receive, or
copies of the child support payments checks or money order receipts.
Name of Person
Who Paid The 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
2012
D. HIGH SCHOOL COMPLETION STATUS
Attach to this worksheet one of the following documents that indicates your high school completion status. If
you are unable to obtain the documentation listed below, you must contact the financial aid office.
A copy of your high school diploma.
A copy of your final official high school transcript that shows the date when the diploma was awarded.
A copy of your General Educational Development (GED) certificate or GED transcript.
An academic transcript that indicates that you successfully completed at least a two-year program that is
acceptable for full credit toward a bachelor’s degree.
If State law requires a homeschooled student to obtain a secondary school completion credential for
homeschool (other than a high school diploma or its recognized equivalent), a copy of that credential.
If State law does not require a homeschooled student to obtain a secondary school completion credential for
homeschool (other than a high school diploma or its recognized equivalent), a transcript or the equivalent,
signed by the your parent or guardian, that lists the secondary school courses the student completed and
documents the successful completion of a secondary school education in a homeschool setting.
________________________
Document Submitted
E. CERTIFICATION & SIGNATURES
Each person signing this worksheet certifies that all of the information reported on it is complete and correct.
_________________________________________________
Student’s Signature
_________________________________________________
Parent’s Signature
_________________________________
Date
_________________________________
Date
Return form to:
Harkins Hall 403, 1 Cunningham Sq., Providence, RI 02918
(e) finaid@providence.edu (p) 401-865-2286 (f) 401-865-1186

COMPLETE SECTION F OR G
F. IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE (must submit document in person)
Identity
You must appear in person at PROVIDENCE COLLEGE to verify your identity by presenting a valid government-issued
photo identification (ID), such as, but not limited to, a driver’s license, other state-issued ID, or passport. The institution will
maintain a copy of your photo ID that is annotated with the date it was received and the name of the official at the institution
authorized to collect your ID.
_____________________
Document Submitted
_____________________
Date Received
Statement of Educational Purpose (must be signed in front of a financial aid representative)
I certify that I _____________________________ am the individual signing this Statement of Educational Purpose and that
the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of
attending PROVIDENCE COLLEGE for 2013-2014.
_____________________ __________________ __________________ __________________
Student’s Signature Date Signed Banner ID Number School Official Name
G. IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE (to be signed in front of a Notary if unable
to appear in person at Providence College)
Identity
If the student is unable to appear in person at PROVIDENCE COLLEGE to verify his or her identity, the student must
provide: (a) A copy of the valid government-issued photo identification (ID) that is acknowledged in the notary statement
below, such as but not limited to a driver’s license, other state-issued ID, or passport; and (b) The original notarized
Statement of Educational Purpose provided below.
Statement of Educational Purpose
I certify that I _____________________________ am the individual signing this Statement of Educational Purpose and that
the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of
attending PROVIDENCE COLLEGE for 2013-2014.
_____________________ __________________ __________________ __________________
Student’s Signature Date Signed Banner ID Number School Official Name
Notary’s Certificate of Acknowledgement
State of _____________________________City/County of ___________________________________
On_______________(date), before me, _______________________________________(Notary Name),
personally appeared, _________________________________(Printed Name of Signer), and provided to
me on basis of satisfactory evidence of identification ________________________(Type of governmentissued
photo ID provided) to be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal:
___________________________________(Notary Signature)
My commission expires on _______________________(Date)