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It takes a minimum of 5 to 10 days for all Verification forms and documentation to be reviewed.
Student's Name

Based on the 2020 Federal Guidelines the amount of income you or your parent (s) reported on the FAFSA appears unusually low in which to support yourself or a family. You or your parent(s) must complete this form and return it to the Financial Aid Office. We need to know that we completely understand your situation and have an accurate picture of how you and your family met their living expenses. This worksheet must be completed before we can verify your eligibility and disburse your federal financial aid. We understand this may be a sensitive issue and we want you to know we respect your privacy; however, we are required to verify this information on the FAFSA. Thank you for your understanding.

When this form is complete bring, scan, mail, or fax this form with all required documentation to the Financial Aid Office at 219 Rock Street, Bluefield WV 24701, FAX# (304)325-7747. You can also complete and submit this form online at “bluefieldstate.edu”, under preferred links, financial aid, and 2022-2023 financial aid documents. ALL supporting documentation must be mailed, faxed, or scan to the financial aid office.
Parent Average Monthly Expenses
$
$
$
$
Parent Resources (Check ALL that apply)
Government Aid (Supplemental Nutrition Assistance Program (SNAP), Infants & Children (WIC), Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), Sections 8 (HUD), Military Benefits (including housing)
$
Child support received
$
Unemployment
$
Worker’s compensation
$
Income from employment
$
Other untaxed income
$
Money received, or aid on your behalf, not reported elsewhere
$
Student (spouse if married) Average Monthly Expenses
$
$
$
$
Student (spouse if married) Resources (Check ALL that apply)
Government Aid (Supplemental Nutrition Assistance Program (SNAP), Infants & Children (WIC), Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), Sections 8 (HUD), Military Benefits (including housing)
$
Child support received
$
Unemployment
$
Worker’s compensation
$
Income from employment
$
Other untaxed income
$
Money received, or aid on your behalf, not reported elsewhere
$

If the above information is ALL zeros or does not sufficiently explain how the household living expenses were met in 2020, you must provide a detailed statement below that will resolve what appears to be conflicting or incomplete information.
 
  • Please include any excluded items (with amounts) from the above table. These amounts will not be included nor counted against your FAFSA EFC, they will help explain how the household survived on so little reported income.
  • We recognize that your household size may not have been the same in 2020 as it is now in 2020. If your income would have reflected an ability to support your 2020 household size, you could include that in your explanation. You might also be making more now than you reported in 2020, and be better able to support your current household size.
By signing this worksheet, you certify that all of the information given is complete and correct. You understand that you may lose consideration for financial aid if you do not submit ALL verification documents in a timely manner.
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