Financial Aid SNAP Benefits

First Name*

Last Name*

Date of Birth*

Date

Social Security Number

E-Mail

Student's Dependency Status

Member of Household Receiving SNAP Benefits:

The household includes:

* The student AND

* The student’s spouse, if the student is married. AND

* The student’s or spouse’s children if the student or spouse will provide more than half of the children’s support from July 1, 2022, through June 30, 2023, even if the children do not live with the student. AND

* Other people if they now live with the student and the student or spouse provides more than half of the other people’s support and will continue to provide more than half of their support through June 30, 2023.

Note: If we have reason to believe that the information regarding the receipt of SNAP benefits is inaccurate, we may require documentation from the agency that issued the SNAP benefits in 2022 or 2023.

The household includes:

* The student. AND

* The parents (including a stepparent) even if the student doesn’t live with the parents. AND

* The parents’ other children if the parents will provide more than half of the children’s support from July 1, 2022, through June 30, 2023, or if the other children would be required to provide parental information if they were completing a FAFSA for 2022–2023. Include children who meet either of these standards even if the children do not live with the parents. AND

* Other people if they now live with the parents and the parents provide more than half of the other people’s support and will continue to provide more than half of their support through June 30, 2023.

Note: If we have reason to believe that the information regarding the receipt of SNAP benefits is inaccurate, we may require documentation from the agency that issued the SNAP benefits in 2022 or 2023.

I certify that the person listed above is a member of the student"s household and received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as the Food Stamp Program) sometime during 2022 or 2023. 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 (1-800-433-3243).

Student Signature (type full name)*

Student Last 4 of SSN

Parent Signature (type full name)*

Parent Last 4 of SSN

SNAP Benefits Verification

STUDENT INFO

RECEIPT OF SNAP BENEFITS

SIGNATURE