{ "document_id": 14387, "filename": "2627-Verification-V5-Independent_Worksheet-Standard.pdf", "engine": "paddleocr_vl", "source_run_id": 14497, "generated_at": "2026-11-04T00:25:13+00:00", "page_count": 6, "counts_by_type": { "figure": 2, "form_field": 41, "header": 6, "heading": 9, "link": 3, "list": 4, "list_item": 14, "table": 4, "table_cell": 60, "text": 41, "title": 1 }, "timings": { "total_ms": 1706, "structure_ms": 540, "text_layer_ms": 26, "build_ms": 16 }, "pages": [ { "document_id": 14387, "page": 1, "width": 612, "height": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 612, "height_pt": 792, "engine": "paddleocr_vl", "source_run_id": 14497, "item_count": 35, "counts_by_type": { "figure": 2, "form_field": 8, "header": 1, "heading": 2, "table": 2, "table_cell": 10, "text": 9, "title": 1 }, "build_ms": 4, "items": [ { "id": "p1.1", "order": 1, "type": "figure", "bbox": { "l": 42, "t": 784.8, "r": 156.48, "b": 702.24 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" }, "reading_order": 0 }, { "id": "p1.2", "order": 2, "type": "header", "bbox": { "l": 320.16, "t": 750.24, "r": 570.72, "b": 702.24 }, "text": "OFFICE OF FINANCIAL AID\nACADEMIC SERVICES #349 | 400 EAST MAIN STREET\nFRANKFORT, KY 40601 | (502) 597-5960 | FAX: (502) 597-5950\nfinaidmail@kysu.edu | KYSU.EDU", "attrs": { "block_label": "header" }, "level": 2, "reading_order": 1 }, { "id": "p1.3", "order": 3, "type": "figure", "bbox": { "l": 0, "t": 785.25, "r": 611.6, "b": 702.0044 }, "text": "", "attrs": { "source": "pdf_image" }, "reading_order": 2 }, { "id": "p1.4", "order": 4, "type": "title", "bbox": { "l": 182.64, "t": 695.28, "r": 446.64, "b": 681.84 }, "text": "2026-2027 Independent Verification V5 Worksheet", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 3 }, { "id": "p1.5", "order": 5, "type": "text", "bbox": { "l": 17.52, "t": 674.64, "r": 286.8, "b": 579.36 }, "text": "Your 2026-2027 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. To verify that you provided correct information the financial aid administrator at your school will compare your FAFSA with the information on this worksheet and with any other required documents. If there are differences, your FAFSA information may need to be corrected.", "reading_order": 4 }, { "id": "p1.6", "order": 6, "type": "text", "bbox": { "l": 17.76, "t": 570.48, "r": 288.96, "b": 486.72 }, "text": "You must complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the financial aid administrator at your school. Your school may ask for additional information. If you have questions about verification, contact your financial aid administrator as soon as possible so that your financial aid will not be delayed.", "reading_order": 5 }, { "id": "p1.7", "order": 7, "type": "heading", "bbox": { "l": 313.92, "t": 672.48, "r": 379.2, "b": 658.8 }, "text": "What to do:", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 6 }, { "id": "p1.8", "order": 8, "type": "text", "bbox": { "l": 332.16, "t": 647.52, "r": 585.84, "b": 588.96 }, "text": "If you did not use the Federal Tax Information Approval (FTI) to complete your FAFSA, request a 2024 IRS tax transcript for yourself (if taxes filed for 2024, and your spouse (if married). See instructions (last page) on how to request a 2024 IRS tax return transcript.", "reading_order": 7 }, { "id": "p1.9", "order": 9, "type": "text", "bbox": { "l": 333.12, "t": 587.52, "r": 496.08, "b": 576.72 }, "text": "Statement for Educational Purpose form.", "reading_order": 8 }, { "id": "p1.10", "order": 10, "type": "text", "bbox": { "l": 333.84, "t": 580.32, "r": 582.72, "b": 517.92 }, "text": "You must appear in person at the KSU Financial Aid office to sign the Identity Statement. If you cannot appear in person, please take the form to a Notary to have it notarized and submit a copy of your identification document. Please note: the notarized form must be mailed to the school.", "reading_order": 9 }, { "id": "p1.11", "order": 11, "type": "text", "bbox": { "l": 331.92, "t": 516, "r": 582.48, "b": 492.96 }, "text": "All parties involved must complete and sign this form. 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"Please Number (include area code)", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 3 }, "children": [ { "id": "p1.14.6.1", "order": 24, "type": "form_field", "bbox": { "l": 378.07, "t": 382.0579, "r": 558.1094, "b": 368.7712 }, "text": "", "attrs": { "field_kind": "text", "source": "blank_line", "label": "ID", "row": 3, "col": 0, "rowspan": 1, "colspan": 3 }, "reading_order": 0 }, { "id": "p1.14.6.2", "order": 25, "type": "form_field", "bbox": { "l": 18, "t": 219.056, "r": 336.05, "b": 203.048 }, "text": "", "attrs": { "field_kind": "text", "source": "blank_line", "row": 3, "col": 0, "rowspan": 1, "colspan": 3, "label": "Please Number (include area code)", "label_source": "parent_text", "label_ref": "p1.14.6" }, "reading_order": 1 } ], "reading_order": 5 } ], "reading_order": 13 }, { "id": "p1.15", "order": 26, "type": "table", "bbox": { "l": 374.64, "t": 370.8, "r": 560.4, "b": 190.01599999999996 }, "text": "", "attrs": { "block_label": "table", "n_rows": 4, "n_cols": 1, 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30, "type": "table_cell", "bbox": { "l": 378.07, "t": 258.51199999999994, "r": 497.314, "b": 245.216 }, "text": "Student's Email Address", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p1.15.3.1", "order": 31, "type": "form_field", "bbox": { "l": 378.07, "t": 274.256, "r": 558.1, "b": 258.248 }, "text": "", "attrs": { "field_kind": "text", "source": "blank_line", "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "label": "Student's Email Address", "label_source": "parent_text", "label_ref": "p1.15.3" }, "reading_order": 0 } ], "reading_order": 2 }, { "id": "p1.15.4", "order": 32, "type": "table_cell", "bbox": { "l": 378.07, "t": 200.81600000000003, "r": 546.658, "b": 190.01599999999996 }, "text": "Alternate Phone Number (i.e. Cell)", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p1.15.4.1", "order": 33, "type": "form_field", "bbox": { "l": 378.07, "t": 219.056, "r": 558.1, 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1, "table_cell": 35, "text": 1 }, "build_ms": 1, "items": [ { "id": "p2.1", "order": 1, "type": "header", "bbox": { "l": 14.64, "t": 755.52, "r": 391.92, "b": 741.84 }, "text": "Student's name: ___\nStudent's ID: ___", "children": [ { "id": "p2.1.1", "order": 2, "type": "form_field", "bbox": { "l": 18, "t": 753.84, "r": 389.3647, "b": 742.8 }, "text": "", "attrs": { "field_kind": "text", "label": "Student's name: ___\nStudent's ID: ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p2.1" }, "reading_order": 0 } ], "level": 2, "reading_order": 0 }, { "id": "p2.2", "order": 3, "type": "heading", "bbox": { "l": 417.12, "t": 755.52, "r": 595.44, "b": 742.08 }, "text": "Student's ID:", "children": [ { "id": "p2.2.1", "order": 4, "type": "form_field", "bbox": { "l": 419.35, "t": 753.84, "r": 594.0714, "b": 742.8 }, "text": "", "attrs": { "field_kind": "text", "label": "Student's ID:", "source": "blank_line", "label_source": "parent_text", "label_ref": "p2.2" }, 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"height": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 612, "height_pt": 792, "engine": "paddleocr_vl", "source_run_id": 14497, "item_count": 10, "counts_by_type": { "form_field": 4, "header": 1, "heading": 1, "text": 4 }, "build_ms": 1, "items": [ { "id": "p4.1", "order": 1, "type": "header", "bbox": { "l": 15.12, "t": 756.48, "r": 392.4, "b": 741.6 }, "text": "Student's name: ___\nStudent's ID: ___", "children": [ { "id": "p4.1.1", "order": 2, "type": "form_field", "bbox": { "l": 18, "t": 753.84, "r": 389.3647, "b": 742.8 }, "text": "", "attrs": { "field_kind": "text", "label": "Student's name: ___\nStudent's ID: ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p4.1" }, "reading_order": 0 } ], "level": 2, "reading_order": 0 }, { "id": "p4.2", "order": 3, "type": "heading", "bbox": { "l": 416.64, "t": 756, "r": 595.68, "b": 741.36 }, "text": "Student's ID:", "children": [ { "id": "p4.2.1", "order": 4, "type": "form_field", "bbox": { "l": 419.35, "t": 753.84, "r": 594.0714, "b": 742.8 }, "text": "", "attrs": { "field_kind": "text", "label": "Student's ID:", "source": "blank_line", "label_source": "parent_text", "label_ref": "p4.2" }, "reading_order": 0 } ], "level": 3, "reading_order": 1 }, { "id": "p4.3", "order": 5, "type": "text", "bbox": { "l": 14.88, "t": 716.88, "r": 596.4, "b": 685.44 }, "text": "D. Certifications and Signatures (Each person signing below certifies that all of the information reported is complete and correct.\nThe student and one parent whose information was reported on the FAFSA must sign and date.", "reading_order": 2 }, { "id": "p4.4", "order": 6, "type": "text", "bbox": { "l": 149.04, "t": 630.24, "r": 234.96, "b": 616.8 }, "text": "Student's Signature", "children": [ { "id": "p4.4.1", "order": 7, "type": "form_field", "bbox": { "l": 69.504, "t": 642.6279, "r": 304.5098, "b": 629.3412 }, "text": "", "attrs": { "field_kind": "text", "source": "blank_line", "label": "Student's Signature", "label_source": "parent_text", "label_ref": "p4.4" }, "reading_order": 0 } ], "reading_order": 3 }, { "id": "p4.5", "order": 8, "type": "text", "bbox": { "l": 437.52, "t": 629.76, "r": 462.72, "b": 617.28 }, "text": "Date", "children": [ { "id": "p4.5.1", "order": 9, "type": "form_field", "bbox": { "l": 357.55, "t": 642.6279, "r": 542.5588, "b": 629.3412 }, "text": "", "attrs": { "field_kind": "text", "source": "blank_line", "label": "Date", "label_source": "parent_text", "label_ref": "p4.5" }, "reading_order": 0 } ], "reading_order": 4 }, { "id": "p4.6", "order": 10, "type": "text", "bbox": { "l": 89.52, "t": 577.92, "r": 520.08, "b": 490.8 }, "text": "WARNING: If you purposely give false or misleading information you may be fined, be sentenced to jail, or both.\nDo not mail this worksheet to the U.S. Department of Education.\nSubmit this worksheet to the financial aid administrator at your school.\nKentucky State University, Financial Aid office\n400 East Main St. ASB Suite 349, Frankfort, KY 40601, Phone: (502) 597-5960 | Fax: (502) 597-5950\nYou should save a copy of this worksheet for your records.", "reading_order": 5 } ] }, { "document_id": 14387, "page": 5, "width": 612, "height": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 612, "height_pt": 792, "engine": "paddleocr_vl", "source_run_id": 14497, "item_count": 17, "counts_by_type": { "form_field": 2, "header": 1, "heading": 1, "link": 3, "list": 1, "list_item": 3, "text": 6 }, "build_ms": 2, "items": [ { "id": "p5.1", "order": 1, "type": "header", "bbox": { "l": 416.88, "t": 755.52, "r": 594.96, "b": 741.84 }, "text": "Student's ID: _____", "attrs": { "block_label": "header" }, "children": [ { "id": "p5.1.1", "order": 2, "type": "form_field", "bbox": { "l": 419.35, "t": 753.84, "r": 594.0714, "b": 742.8 }, "text": "", "attrs": { "field_kind": "text", "label": "Student's ID: _____", "source": "blank_line", "label_source": "parent_text", "label_ref": "p5.1" }, "reading_order": 0 } ], "level": 2, "reading_order": 0 }, { "id": "p5.2", "order": 3, "type": "text", "bbox": { "l": 14.88, "t": 756, "r": 391.44, "b": 741.84 }, "text": "Student's name: ___", "children": [ { "id": "p5.2.1", "order": 4, "type": "form_field", "bbox": { "l": 18, "t": 753.84, "r": 389.3647, "b": 742.8 }, "text": "", "attrs": { "field_kind": "text", "label": "Student's name: ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p5.2" }, "reading_order": 0 } ], "reading_order": 1 }, { "id": "p5.3", "order": 5, "type": "heading", "bbox": { "l": 15.36, "t": 727.44, "r": 162.72, "b": 711.84 }, "text": "Using The Tax Transcript", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 2 }, { "id": "p5.4", "order": 6, "type": "text", "bbox": { "l": 15.36, "t": 693.12, "r": 587.76, "b": 642.24 }, "text": "If students cannot or will not use the DRT, either at initial FAFSA filing or through online corrections, you can use an IRS tax return transcript for the student, spouse, and/or parents, as applicable, to document AGI, taxes paid, and untaxed income.", "reading_order": 3 }, { "id": "p5.5", "order": 7, "type": "text", "bbox": { "l": 15.36, "t": 624.48, "r": 593.76, "b": 556.8 }, "text": "Before requesting a transcript, they should allow enough time to pass after filing the return; it takes the IRS 2 to 4 weeks to process returns filed electronically and 6 to 8 weeks for mailed returns. Tax transcripts submitted to your school for verification do not need to be signed by the tax filer (but it is encouraged) unless you have reason to doubt their authenticity.", "reading_order": 4 }, { "id": "p5.6", "order": 8, "type": "text", "bbox": { "l": 15.12, "t": 526.8, "r": 590.64, "b": 472.08 }, "text": "There are a few ways to request a tax return transcript: online at www.irs.gov/individuals/get-transcript, by calling 1-800- 908-9946, or by mailing the paper Form 4506-T-EZ, which can be printed from the IRS website.", "children": [ { "id": "p5.6.1", "order": 9, "type": "link", "bbox": { "l": 386.76, "t": 528.59, "r": 596.25, "b": 508.94 }, "text": "www.irs.gov/individuals/get-", "attrs": { "uri": "http://www.irs.gov/individuals/get-transcript", "action_type": "/URI" }, "reading_order": 0 }, { "id": "p5.6.2", "order": 10, "type": "link", "bbox": { "l": 15.75, "t": 508.94, "r": 75.416, "b": 489.29 }, "text": "transcript,", "attrs": { "uri": "http://www.irs.gov/individuals/get-transcript", "action_type": "/URI" }, "reading_order": 1 } ], "reading_order": 5 }, { "id": "p5.7", "order": 11, "type": "text", "bbox": { "l": 15.36, "t": 441.12, "r": 592.8, "b": 390.72 }, "text": "The Get Transcript Online feature allows users to get the transcript in real time as a portable document format (PDF) file, which they can submit electronically to a school or print and submit as a hard copy. To use the Get Transcript Online tool, users must have:", "reading_order": 6 }, { "id": "p5.8", "order": 12, "type": "list", "bbox": { "l": 15.6, "t": 388.8, "r": 581.28, "b": 317.04 }, "text": "", "attrs": { "item_count": 3 }, "children": [ { "id": "p5.8.1", "order": 13, "type": "list_item", "bbox": { "l": 16.08, "t": 388.8, "r": 233.52, "b": 374.3 }, "text": "access to a valid email address,", "reading_order": 0 }, { "id": "p5.8.2", "order": 14, "type": "list_item", "bbox": { "l": 16.08, "t": 369.6, "r": 327.6, "b": 354.72 }, "text": "a text-enabled mobile phone in their name, and", "marker": "-", "reading_order": 1 }, { "id": "p5.8.3", "order": 15, "type": "list_item", "bbox": { "l": 15.6, "t": 350.4, "r": 581.28, "b": 317.04 }, "text": "specific financial account numbers, such as a credit card number or an account number for a home mortgage or auto loan. The process will not cause charges to the card or the account.", "marker": "•", "reading_order": 2 } ], "reading_order": 7 }, { "id": "p5.9", "order": 16, "type": "text", "bbox": { "l": 15.6, "t": 299.52, "r": 565.92, "b": 266.4 }, "text": "See the https://www.irs.gov/individuals/get-transcript website for more information on the Get Transcript Service.", "children": [ { "id": "p5.9.1", "order": 17, "type": "link", "bbox": { "l": 61.455, "t": 300.92, "r": 330.33, "b": 283.83 }, "text": "https://www.irs.gov/individuals/get-transcript", "attrs": { "uri": "https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.irs.gov%2Findividuals%2Fget-transcript&data=05%7C01%7CJoshua.Back%40kysu.edu%7C585bb8a19de04053a74408db403e8bbe%7Ccb83c95fc0144330bfdc88e488123ca5%7C0%7C0%7C638174409614961455%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=hUhPSatJ6k0kTaRIs8alsFsthiz03y%2FeogePSY2NiQI%3D&reserved=0", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 8 } ] }, { "document_id": 14387, "page": 6, "width": 612, "height": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 612, "height_pt": 792, "engine": "paddleocr_vl", "source_run_id": 14497, "item_count": 37, "counts_by_type": { "form_field": 11, "header": 1, "heading": 3, "list": 1, "list_item": 2, "text": 19 }, "build_ms": 5, "items": [ { "id": "p6.1", "order": 1, "type": "header", "bbox": { "l": 33.36, "t": 746.88, "r": 543.6, "b": 733.44 }, "text": "Student's name: ___ Student's ID: ___", "children": [ { "id": "p6.1.1", "order": 2, "type": "form_field", "bbox": { "l": 36, "t": 747.5734, "r": 540.924, "b": 734.2843 }, "text": "", "attrs": { "field_kind": "text", "label": "Student's name: ___ Student's ID: ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p6.1" }, "reading_order": 0 } ], "level": 2, "reading_order": 0 }, { "id": "p6.2", "order": 3, "type": "heading", "bbox": { "l": 33.84, "t": 718.8, "r": 286.56, "b": 705.6 }, "text": "E. Identity and Statement of Educational Purpose", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p6.3", "order": 4, "type": "heading", "bbox": { "l": 203.28, "t": 690.96, "r": 407.28, "b": 679.68 }, "text": "Identity and Statement of Educational Purpose", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 2 }, { "id": "p6.4", "order": 5, "type": "text", "bbox": { "l": 233.76, "t": 679.68, "r": 378.48, "b": 668.64 }, "text": "(To Be Signed At the Institution)", "reading_order": 3 }, { "id": "p6.5", "order": 6, "type": "text", "bbox": { "l": 33.36, "t": 668.16, "r": 561.6, "b": 632.88 }, "text": "INSTRUCTIONS: The student must appear in person at Kentucky State University (KSU) to verify his/her identity by presenting valid government-issued photo identification (ID), such as driver's license, other state-issued ID, or passport. If the student cannot appear at KSU in person, please have this form notarized.", "reading_order": 4 }, { "id": "p6.6", "order": 7, "type": "text", "bbox": { "l": 68.4, "t": 622.8, "r": 393.12, "b": 611.52 }, "text": "Statement of Educational Purpose", "reading_order": 5 }, { "id": "p6.7", "order": 8, "type": "text", "bbox": { "l": 68.88, "t": 610.56, "r": 397.68, "b": 600 }, "text": "I certify that I _____ am the individual signing this", "children": [ { "id": "p6.7.1", "order": 9, "type": "form_field", "bbox": { "l": 72.024, "t": 612.7079, "r": 395.6706, "b": 599.4212 }, "text": "", "attrs": { "field_kind": "text", "label": "I certify that I _____ am the individual signing this", "source": "blank_line", "label_source": "parent_text", "label_ref": "p6.7" }, "reading_order": 0 } ], "reading_order": 6 }, { "id": "p6.8", "order": 10, "type": "text", "bbox": { "l": 128.4, "t": 599.28, "r": 225.12, "b": 588.48 }, "text": "(Print Student's Name)", "reading_order": 7 }, { "id": "p6.9", "order": 11, "type": "text", "bbox": { "l": 69.6, "t": 587.52, "r": 400.08, "b": 576.72 }, "text": "Statement of Educational Purpose and that the federal student financial assistance", "reading_order": 8 }, { "id": "p6.10", "order": 12, "type": "text", "bbox": { "l": 69.84, "t": 576.24, "r": 556.32, "b": 553.68 }, "text": "I may receive will only be used for educational purposes and to pay the cost of attending Kentucky State University for 2025-2026.", "reading_order": 9 }, { "id": "p6.11", "order": 13, "type": "text", "bbox": { "l": 72, "t": 537.6, "r": 354.24, "b": 527.04 }, "text": "___", "children": [ { "id": "p6.11.1", "order": 14, "type": "form_field", "bbox": { "l": 72.0231, "t": 541.9979, "r": 349.5817, "b": 528.7112 }, "text": "", "attrs": { "field_kind": "text", "source": "blank_line" }, "reading_order": 0 } ], "reading_order": 10 }, { "id": "p6.12", "order": 15, "type": "text", "bbox": { "l": 70.08, "t": 527.76, "r": 354.96, "b": 516.48 }, "text": "(Student's Signature) (Date)", "reading_order": 11 }, { "id": "p6.13", "order": 16, "type": "text", "bbox": { "l": 33.6, "t": 491.04, "r": 549.6, "b": 478.32 }, "text": "If the student is unable to appear in person at Kentucky State University to verify his or her identity, the student must provide:", "reading_order": 12 }, { "id": "p6.14", "order": 17, "type": "list", "bbox": { "l": 69.84, "t": 468.24, "r": 556.56, "b": 432.48 }, "text": "", "attrs": { "item_count": 2 }, "children": [ { "id": "p6.14.1", "order": 18, "type": "list_item", "bbox": { "l": 70.08, "t": 468.24, "r": 556.56, "b": 445.44 }, "text": "A copy of the valid government-issued photo identification (ID) that is acknowledged in the notary statement below, such as but not limited to a driver's license, other state-issued ID, or passport; and", "marker": "(a)", "reading_order": 0 }, { "id": "p6.14.2", "order": 19, "type": "list_item", "bbox": { "l": 69.84, "t": 444.48, "r": 383.28, "b": 432.48 }, "text": "The original notarized Statement of Educational Purpose provided below.", "marker": "(b)", "reading_order": 1 } ], "reading_order": 13 }, { "id": "p6.15", "order": 20, "type": "heading", "bbox": { "l": 214.56, "t": 422.16, "r": 396.24, "b": 410.16 }, "text": "Notary's Certificate of Acknowledgement", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 14 }, { "id": "p6.16", "order": 21, "type": "text", "bbox": { "l": 33.6, "t": 405.36, "r": 526.8, "b": 393.12 }, "text": "State of ___ City/County of ___", "children": [ { "id": "p6.16.1", "order": 22, "type": "form_field", "bbox": { "l": 36, "t": 406.4379, "r": 524.6088, "b": 393.1512 }, "text": "", "attrs": { "field_kind": "text", "label": "State of ___ City/County of ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p6.16" }, "reading_order": 0 } ], "reading_order": 15 }, { "id": "p6.17", "order": 23, "type": "text", "bbox": { "l": 33.6, "t": 387.36, "r": 534.48, "b": 375.12 }, "text": "On___, before me, ___, personally appeared, ___, and", "children": [ { "id": "p6.17.1", "order": 24, "type": "form_field", "bbox": { "l": 36, "t": 388.9179, "r": 533.2029, "b": 375.6313 }, "text": "", "attrs": { "field_kind": "text", "label": "On___, before me, ___, personally appeared, ___, and", "source": "blank_line", "label_source": "parent_text", "label_ref": "p6.17" }, "reading_order": 0 } ], "reading_order": 16 }, { "id": "p6.18", "order": 25, "type": "text", "bbox": { "l": 31.92, "t": 370.08, "r": 508.56, "b": 311.04 }, "text": "(Date)\n(Notary's name)\n(Printed name of Signer)\nprovided to me on basis of satisfactory evidence of identification,_____ to be\n(Type of government-issued photo ID provided)\nwho signed the foregoing instrument.", "children": [ { "id": "p6.18.1", "order": 26, "type": "form_field", "bbox": { "l": 36, "t": 353.9779, "r": 505.611, "b": 340.6912 }, "text": "", "attrs": { "field_kind": "text", "label": "provided to me on basis of satisfactory evidence of identification, to be", "source": "blank_line", "label_source": "parent_text", "label_ref": "p6.18" }, "reading_order": 0 } ], "reading_order": 17 }, { "id": "p6.19", "order": 27, "type": "text", "bbox": { "l": 33.84, "t": 297.6, "r": 572.16, "b": 284.64 }, "text": "WITNESS my hand and official seal _____ My commission expires on _____", "children": [ { "id": "p6.19.1", "order": 28, "type": "form_field", "bbox": { "l": 36, "t": 298.1779, "r": 571.8032, "b": 284.2936 }, "text": "", "attrs": { "field_kind": "text", "label": "WITNESS my hand and official seal _____ My commission expires on _____", "source": "blank_line", "label_source": "parent_text", "label_ref": "p6.19" }, "reading_order": 0 } ], "reading_order": 18 }, { "id": "p6.20", "order": 29, "type": "text", "bbox": { "l": 31.92, "t": 288.72, "r": 576.24, "b": 180.96 }, "text": "(Notary signature) (Date)\n(Seal if available)", "reading_order": 19 }, { "id": "p6.21", "order": 30, "type": "text", "bbox": { "l": 34.08, "t": 174, "r": 560.4, "b": 161.04 }, "text": "Office Use Only: Verification Group: ___ Date: ___ Init: ___ [] RRAAREQ Update [ ] RHACOMM Update", "children": [ { "id": "p6.21.1", "order": 31, "type": "form_field", "bbox": { "l": 36, "t": 174.9078, "r": 213.7681, "b": 161.0236 }, "text": "", "attrs": { "field_kind": "text", "label": "Office Use Only: Verification Group: ___ Date: ___ Init: ___ [] RRAAREQ Update [ ] RHACOMM Update", "source": "blank_line", "label_source": "parent_text", "label_ref": "p6.21" }, "reading_order": 0 }, { "id": "p6.21.2", "order": 32, "type": "form_field", "bbox": { "l": 252.0498, "t": 174.9078, "r": 558.952, "b": 161.6212 }, "text": "", "attrs": { "field_kind": "text", "label": "Date: Init. [ ] RRAAREQ Update [ ] RHACOMM Update", "source": "blank_line", "label_source": "parent_text", "label_ref": "p6.21" }, "reading_order": 1 } ], "reading_order": 20 }, { "id": "p6.22", "order": 33, "type": "text", "bbox": { "l": 35.04, "t": 150.96, "r": 504.24, "b": 137.76 }, "text": "[ ] Identity confirmation Document: _____ [ ] Copy of Identification document attached", "children": [ { "id": "p6.22.1", "order": 34, "type": "form_field", "bbox": { "l": 36, "t": 151.6279, "r": 502.0421, "b": 138.3412 }, "text": "", "attrs": { "field_kind": "text", "label": "[ ] Identity confirmation Document: _____ [ ] Copy of Identification document attached", "source": "blank_line", "label_source": "parent_text", "label_ref": "p6.22" }, "reading_order": 0 } ], "reading_order": 21 }, { "id": "p6.23", "order": 35, "type": "text", "bbox": { "l": 34.8, "t": 127.92, "r": 579.12, "b": 113.04 }, "text": "[ ] Signature/ Identity Witnessed by: ___ [ ] Original Notarized Document received on ___/___/___", "children": [ { "id": "p6.23.1", "order": 36, "type": "form_field", "bbox": { "l": 36, "t": 128.2278, "r": 551.8552, "b": 114.9412 }, "text": "", "attrs": { "field_kind": "text", "label": "[ ] Signature/ Identity Witnessed by: ___ [ ] Original Notarized Document received on ___/___/___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p6.23" }, "reading_order": 0 } ], "reading_order": 22 }, { "id": "p6.24", "order": 37, "type": "text", "bbox": { "l": 33.6, "t": 106.32, "r": 570.48, "b": 54.48 }, "text": "Do not mail this worksheet to the U.S. Department of Education. Submit this worksheet to the financial aid administrator at your school. Kentucky State University Financial Aid office, 400 East Main St. ASB Suite 349, Frankfort, KY 40601 finaidmail@kysu.edu, Phone: (502) 597-5960, Fax: (502) 597-5950 You should make a copy of this worksheet for your records.", "reading_order": 23 } ] } ] }