02/04/2013
Rose State College
Office of Student Financial Aid
6420 SE 15th Street
Midwest City, Oklahoma 73110
Phone (405) 733-7424 Fax (405) 736-0359
Website http://www.rose.edu Email finaid@rose.edu
2013-2014 Supplemental Nutrition Assistance Program (SNAP) Verification Form
Student Name: _______________________________ RSC Student ID#:_______________________
On your Free Application for Federal Student Aid (FAFSA) you indicated someone in your or your parent’s household (if you were required to report parent information on your FAFSA) received Food Stamps – Supplemental Nutrition Assistance Program benefits (SNAP) in 2011 or 2012.
Please complete the following information regarding the supplemental nutrition assistance.
□ A member of my household, who is listed on my 2013-2014 FAFSA, did receive Supplemental Nutrition Assistance (SNAP) in 2011 or 2012, and if asked will provide documentation of the receipt of the SNAP benefits.
□ No member of my household, who is listed on my 2013-2014 FAFSA, received Supplemental Nutrition Assistance (SNAP) in 2011 or 2012.
I certify that all of the information reported on this form is complete and correct.
_____________________________________________ ______________________
Student Signature Date
□ A member of my parent’s household, who is listed on my 2013-2014 FAFSA, did receive Supplemental Nutrition Assistance (SNAP) in 2011 or 2012, and if asked will provide documentation of the receipt of the SNAP benefits.
□ No member of my parent’s household, who is listed on my 2013-2014 FAFSA, received Supplemental Nutrition Assistance (SNAP) in 2011 or 2012.
Each person signing this form certifies that all of the information reported on it is complete and correct.
_______________________________________________ _______________________
Student Signature Date
_______________________________________________ ________________________
Parent Signature Date
INDEPENDENT STUDENT
DEPENDENT STUDENT
