Financial Aid Office ● 197 Franklin St. • Auburn, NY 13021
315-255-1743 ext. 2470 • Fax 315-252-2185
2014-2015 SNAP (FOOD STAMP) CONFIRMATION
Student’s Printed Name Cayuga ID #
You indicated on your FAFSA that you or your parents (if dependent student) received Food Stamps in 2012 or 2013. Please indicate below if this information is correct and provide the required documentation by completing the following form. Once you have entered the necessary information, you will need to print the form and provide all required signatures and return it to the CCC Financial Aid Office with supporting documentation, if necessary.
□ I received Food Stamps in 2012 or 2013
Please attach a copy of your current Common Benefit identification Card (CIBC)
□ I did not received Food Stamps in 2012 or 2013
Please contact the Financial Aid Office regarding corrections to your FAFSA
I certify that the above information is true and complete. I understand that failure to accurately report
Information may jeopardize my eligibility for Financial Aid. I also understand that the U.S. Secretary of
Education has the authority to verify information reported on the FAFSA with the Internal Revenue Service and other federal agencies. I understand that giving false or misleading information may lead to fines up to $20,000, prison, or both.
Student Signature:________________________________________________ Date:_______________
Dependent Students Only
Parent Printed Name:_______________________________________________________________________________
Parent Signature:_________________________________________________ Date:_______________
Return this form to the Financial Aid Office at Cayuga Community College
along with a copy of your Common Benefit Card, if necessary.