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Contents : 2010-2011 FAFSA Verification Worksheet All information should be sent or faxed to: Philander Smith College Office of Financial Aid 900 Daisy Bates Dr. Little Rock AR 72202 Fax: (501) 370-5357 If you have questions you may reach us at: Cox Administration Building Room 110 Phone: (501) 370-5350 Your Free Application for Federal Student Aid (FAFSA) was selected for review by the U.S. Department of Education in a process called Verification . This means Philander must compare the information from your FAFSA your 2009 Federal tax forms this worksheet and other financial documents. If there are differences between your FAFSA information and your financial documents additional information may be requested and/or corrections will be processed. The law says that we have the right to ask you for this information and resolve any conflicts before awarding Federal financial aid (34 CFR Part 668). You must provide Philander Smith College with the following: You may contact the IRS at 1-800-829-1040 or http://www.irs.gov/ if you need copies of your tax forms. You should provide all required information as soon as possible. Attach an additional sheet if necessary. Your Federal financial aid awards will not be offered until the verification review is completed and validated. Last Name First Name - M.I. - / SSN PSC ID Address (include apt. no.) Date of birth City Phone number (include area code) State ZIP code DETERMINE DEPENDENCY STATUS AND IDENTIFY WHICH SECTIONS MUST BE COMPLETED Circle your answer to each question below to determine what sections of this worksheet must be completed 1. Were you born before January 1 1987 YES NO 9. Are you or were you an emancipated minor as determined by a court in your state of legal residence YES NO YES NO 2. As of today are you married 10. Are you or were you in legal guardianship as determined by a court in your state of legal residence YES NO 3. Will you be working on a masters or doc torate (MA MBA JD PhD EdD) degree YES NO 11. At any time after July 1 2009 did your high school or school district homeless liaisons determine that you were 4. Are you currently serving on active duty the US an unaccompanied youth who was homeless YES NO Armed Forces for purposes other than training YES NO 12. At any time on or after July 1 2009 did the director of an emergency shelter or transitional housing program 5. Are you a veteran of the Armed Forces YES NO funded by HUD determine that you were an unaccompanied youth who was homeless YES NO 6. Do you have children who will receive more than half of their support from you between 13. At any time on or after July 1 2009 did the director of July 1 2009 and July 1 2010 YES NO a runaway or homeless basic center or transitional Living program determine that you were an unaccompanied 7. Do you have dependents other than your children youth who was homeless or were self supporting and at risk or spouse who lives with you and who will of being homeless YES NO receive more than half of their support from If you answered YES to ANY question you are an Independent student. You must you YES NO Provide information for you and your spouse (if you are married). Complete sections 8. At any time since you turned 13 were both your A B C E and F. parents deceased were you in foster care or were If you answered NO to All questions you are a Dependent student. You must you a dependent or ward of the court YES NO provide information for you and your parent(s). Complete sections A B D E and F. If you answered YES to questions 8 9 10 11 12 or 13 additional information will be required. A. HOUSEHOLD INFORMATION List yourself spouse (if married) and your children. List other people if they now live with you and you will provide INDEPENDENT STUDENT more than half of their support from July 1 2009 - June 30 2010 (legal documentation of support will be required). DEPENDENT STUDENT List yourself and your parent(s) (including step-parent) even if you don t live with your parents. Include your parent s other children even if they don t live with your parent(s) if (a) your parents will provide more than half their support from July 1 2009 June 30 2010 or (b)the children would be required to provide parental information on their FAFSA. Full Name Age Relationship to Student Self College Attending in 2010--2011 Philander Smith College B. STUDENT TAX FORM AND INCOME/BENEFIT INFORMATION Check one: Required to file a 2009 U.S. Income Tax Return. Attaching or will submit signed copy to PSC by . Will not file and not required to file

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