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2017-2018 Verification Worksheet for Dependent Student

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Your 2017-2018 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that before disbursing Federal Student Aid, your school must confirm certain information reported on your F AFSA.

The student and at least one parent must complete and sign this worksheet. Submit the form and other required documents to your college's Financial Aid Office . Jf additional information is required, it will be specified on line within the Financial Aid pages of Banner Self-Service, so check frequently for updates and any outstanding requirements.

To verify that FAFSA information is correct , the financial aid administrator at your college will compare your FAFSA with the information on this worksheet and any other required documents. If there are differences, your FAFSA information may be corrected. If you have questions contact your colle~c' s Financial Aid Office as soon as possible to avoid delays in receivin 1; your aid .

A. Dependent Student's Information

Student ' s Last Name Student's First Name Student's M.I.

Student's Street Address (include apt. no.)

City State Zip Code

Student's Email Address

B. Dependent Student's Family/Housel10ld Information

Student/ Banner ID Number

Student's Date ofBi11h

Student's Home or Cell Phone Number

(include area code)

In the table below, list the people in the student's parenl{s)' household. Include:

• Student (list first)

• Parent(s) (including a stepparent) even if the student does not live with the parents

• If parents are divorced, include information about the parent(s) & household in which the student resides most often.

• Parent(s)' other children ifthe parent(s) will provide more than halfoftheir support from July 1, 2017, through June 30,

2018 , -OR- if the other children would be required to provide parental information if they were completing a FAFSA for 2017-2018 . Include children who meet either of these standard s, even if they do not live with the parent(s).

• Other people if they now live with the parent(s) and the parent(s) provide more than half of their support and will continue to

provide more than half of their support through June 30, 2018 .

College Information: Include the name of the college/school for any listed household member who is. or wh o will be, enrolled

at least halftime (6 credits or more) in a degree, diploma, or certificate program at an eligible postsecondary educational

institution any time between July I, 2017, and June 30, 2018. Additional documentation may be required.

Relationship Will be Enrolled at Full Name Age to Student College Least Half Time

Missy Jones (exqmple) 1/'ii\l' •• I 18 Sister Central University ·~ · . .,;Yes.: l .. , .• ..

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Jf more space is needed, include an additi onal pa ge with the student's name and Student ID # at the top.

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Student's Name: _ __ _ _ __ __ ____ __ __ _ Student/Banner ID: ___ _ ___ _ __ _

C. Filer Only: Verification of 2015 Income Information for Depend 111 Sf'uden1 Tax Return l<ilers

Instructions: Complete this section only if the student filed or will file a 2015 IRS income tax return. If the student did not file and was not required to file a 2015 return, complete section E instead.

For Tax Return Filers, check the box below that applies:

0 The student has already used the JRS Data Retrieval Tool (IRS DRT) in FA FSA on the Web to transfer 20 I 5 IRS income tax return information into the student's FAFSA. and has made no changes to that IRS data. Note: The IRS DRT that is part of FAFSA on the Web at FA FSA.gov is currently unavailable .

D The sttident instead will provide the school a SIGNED copy of the Student's filed 2015 IRS Income Tax Return - OR- a 2015 IRS Tax Return Transcript of the studen1's return.

_ Check here if a copy of the student's SIGNED IRS Tax Return -OR- the student's IRS Tax Return Transcript is included with this worksheet.

_ Check here if a copy of the student's SIGNED IRS Tax Return -OR- the student's IRS Tax Return Transcript will be submitted to the school later.

For more information, see separate document Providing Income and Tax Information When Your FA FSA is Selected for J/erif/cation

D. Filers Only: Verification of 2015 Income Information for Parent Tax Return Filer

Instructions: Complete this section only if the parent(s) filed or will file a 2015 IRS income tax return(s). Information for each parent in the household must be included. If the parent(s) did not file and were not required to file a 2015 return , complete section F instead .

For Tax Return Filers, check the box below that applies:

0 The parent(s) have already used the IRS Data Retrieval Tool (IRS DRT) in FAFSA on the Web to transfer 2015 IRS income tax return infi ,·malion into the student's FAFSA and have made no changes to that IRS data. Note: The IRS DRT that is part of FAFSA on the Web at l'IIFSA. gov is currently unavailable.

D The parent(s) instead will provide the school a SIGNED copy of the Parent(s)' filed2015 IRS Income Tax Return - OR- a 20 I 5 IRS Tax Return Transcript of the parent(s)' return.

_ Check here if the parenl(s) 'SIGNED copy/copies of the IRS Tax Return -OR- the parenl(s) 'IRS Tax Return Transcript(s) are included with this worksheet.

_ Check here if the parenl{s) 'SIGNED copy/copies of the IRS Tax Return -OR- the parent(s) 'IRS Tax Return Transcript(s) will be submitted to the school later.

For more information, see separate document Providing Jncome and Tax Information When Your FA FSA is Selected for Verification

Please do not forget to sign and date the last page of this document.

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Student's Name: __ __ __ ___ __ __ ___ _ _ Student/Banner ID: _ __ __ __ __ _ _

E. Non-Filers Only: Verification of 2015 Income for Dependent Student Not Required to File a Tax Return

Instructions: Complete this section only if the student will not file AND is not required to file a 2015 IRS income tax return. If the student did/will file a 2015 return or is required to file, skip this section and complete Section C and associated requirements instead .

For information about filing requirements, review "Do I Need to File a Tax Return?" on www.JRS.gov .

For Non-Filers, check the box below that applies:

0 The student was not employed and had no income earned from work in 2015.

0 The student did not file and was not requir ed to file , but was employed in 2015 and has listed in the chart below the

names of all the student's employers, the amount earned from each employer in 2015, and whether an JRS W-2 form is

included.

Additional R quirement for Non-Filers Only:

Provide copies of all 2015 IRS W-2 forms issued to the student by employers.

List every employer below, even ift/1ey did not issue an IRS W-2form.

Student's Employer's Name 2015 Amount Earned IRS W-2 Provided? 1,,t (example)Su;,i 's Auto Body 'hop. (µamvlg.) $2,'.000. OO(e~amp{e) Yes{extimp1~) •., ..

If more space is needed, include an additional page with the student's name and Student ID # at the top.

Please do not forget to sign and date the last page of this document.

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Student's Name: _ _______ _ ____ _ ____ Student/ Banner ID: _ __ __ ___ _ _ _

F. Non-Filers Only: Verification of 2015 Income for Parent(s) Not Required to File a Tax Return

Instructions: Complete this section only if the parent(s) will not file AND are not required to file a 2015 IRS income tax return(s). Information for each parent in the household must be included. If the parent(s) did/will file a 2015 return or are required to file, skip this section and complete Section D and associated requirements instead.

For information about filing requirements, review "Do I Need to File a Tax Return?" on 1,,1,ww.JRS.gov.

For Non-Filers, check the box below that applies:

D The parent(s) were not employed and had no income earned from work in 2015.

D The parent(s) did not file and were not required to file, but were employed in 2015 and have listed in the chart below the

names of all the parent(s)' employers, the amount earned from each employer in 2015, and whether an IRS W-2 form is

included.

Additional Requirement for Non -Filers Only: Provide copies of all 2015 IRS W-2 forms issued to the parent(s) by employers.

List every employer below, even if they did not issue an IRS W-2 form.

Parent(s)' Employer's Name 2015 Amount Earned IRS W-2 Provided? (example) Suzy's',foto I}oij;F~hbp,(~ample) ' 't $2. OPo. 0O,(exa111ple)' 'res(exa!nple)

If more space is needed, include an additional page with the student's name and Student TD # al the top.

Please do not forget to sign and date the last page of this document.

G. Certification and Signatures

Each person signing this worksheet certifies that all of the

information reported on it is complete and correct.

WARNING: If you purposely give false or

misleading information on this worksheet, you

may be fined, sent to prison, or both.

The student and one parent whose information is reported on the FAFSA must sign and date below.

Student's Signature Date

Parent's Signature Date

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Submit this worksheet and any otlter required documentation to tlte financial aid administrator at your college.

Illegible or missing information will delay processing and awarding of financial aid. Ensure tltat all relevant sections are completed. If a section does not apply to you, mark it as "NIA" or "Not Applicable."

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2017-2018 Award Year (V41VS)

Verification of Student Identity and Statement of Educational Purpose

Student Information:

Last Name First Nan1c Middle Initial Student/Banner ID Number

Instructions: Students who are required to verify their identity and educational purpose may do so in two ways, depending on their ability to complete the process at their college:

Option A: Students who are able to return this document to their college's Financial Aid Office in person must 1. Verify identity by presenting unexpired valid government-issued photo identification (ID) , such as, but not

limited to, a driver's license, other state-issued ID, or passport. The college will maintain a copy of the student's photo JD that is annotated by the oni cial with the date ii wns received and reviewed, as w·ell as the name of the Financial Aid official authorized to receive and review the student's TD.

2. Sign, in the presence of the Financial Aid official, the Statement of Educational Purpose provided below.

Option B: Students unable 10 appear in person at their college to verify identity must: 1. Present valid, 1111c:-:pir~d government-issued photo identification (TD) to a Notary such as but not limited to a

driver's I icense, other state-issued ID, or passport. 2. Provide to the college a copy of that ID that is acknowledged in the notary statement below. 3. Sign, in the presence ofa Notary, the Statement of Educational Purpose provided below. 4. Have the Notary complete the Notary's Certificate of Acknowledgement provided below. 5. Mail the copy of the ID & this completed fonn with Notary's Certificate to the college's Financial Aid Office.

~ -Statement of Education~! Purnose

J certify that I _ ___ ___ __ ___ _ am the individual signing this Statement of Educational Purpose (Print Student's Name)

and that the Federal student financial assistance I may receive will only be used for educational purposes and to pay

the cost of attending __ _____ _ _ _ __ __ _ _ _ _ _ for 2017-2018. (Name of Postsecondary Educational Institution)

(Student's Signature) (Date) (Student's ID Number)

(Name of Authoriz.ed College Official) (Date) (Tille ofOfficial)

Notary's Certificate of Acknowledgement (Required only if signed in the presence of a Notary)

State of - ---- --- City/County or _____ _______ _____ __ ,. ___ _

On ______ _____ ____ , before me, __ _ ___ __ _______ , personally appeared,

(Date) (Nota1y's Name) _ __ ____ _ _ ___ __ __ and proved to me on basis of satisfactory evidence of identification

(Printed Name of Student Signer) ___ _____ _ ____ _ __ to be the above-named person who signed the foregoing instrument.

(Type of unexpired gov't-issued photo ID provided)

WITNESS my hand and official seal (Notary signature)

(seal) My commission expires on _______ ____ .,., ___ ____ _ (Date)