2016-17 Verification Worksheet

Independent Student – V6

Your 2016-2017 Free Application for Student Aid (FAFSA) was selected for a review in a process called verification. The law says that before awarding Federal Student Aid, we may ask you to confirm the information you reported on your FAFSA. 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 required documents. If there are differences, your FAFSA information may need to be corrected. You must complete and sign this worksheet, attach any required documents, and submit the form 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.

A. Student Information

______Last Name First Name M. I. Social Security Number

______Address (include apt. no.) Date of Birth

______City State Zip Code Phone Number (include area code)

B. Family Information

List the people in your household. Include:  Yourself.  Your spouse, if you are married.  Your children, if any, if you will provide more than half of their support from July 1, 2016, through June 30, 2017, or if the child would be required to provide your information if they were completing a FAFSA for 2016-2017. Include children who meet either of these standards, even if they do not live with you.  Other people if they now live with you and you provide more than half of their support and will continue to provide more than half of their support through June 30, 2017.

Include the name of the college for any household member who will be enrolled, at least half time in a degree, diploma, or certificate program at a postsecondary educations institution any time between July 1, 2016, and June 30, 2017. If more space is needed, attach a separate page with the student’s name and Social Security Number at the top.

Full Name Age Relationship College Will be Enrolled at Least Half Time Missy Jones (example) 18 Wife Central University Yes Self TAX RETURN FILERS – Important Note: If you (or your spouse, if married) filed, or will file, an amended 2015 IRS tax return, or granted a filing extension by the IRS, the student must contact the financial aid administrator before completing section C.

Instructions: Complete these sections if you, the student (or your spouse if married), filed or will file a 2015 income tax return with the IRS. The best way to verify income is by using the IRS Date Retrieval Tool that is part of FAFSA on the Web. If you have not already used the tool, go to FAFSA.gov, log in to your FAFSA record, select “Make FAFSA Corrections,” and navigate to the Financial Information section of the form. From there, follow the instructions to determine if you are eligible to use the IRS Data Retrieval to transfer 2015 IRS income tax information into the student’s FAFSA. It takes up to 2-3 weeks for the IRS income information to be available for the IRS Data Retrieval Tool for electronic IRS tax return filers, and up to 8-11 weeks for paper IRS tax return filers. If you need more information about when, or how to use the IRS Data Retrieval Tool see your financial aid administrator.

C. Student’s Tax Forms and Income Information (all applicants)

1. Check only one box below. Tax transcripts include the 2015 IRS transcript filing Form 1040, 1040A, and 1040EZ.  Check here if you are updating your 16-17 FAFSA by using the IRS Data Retrieval Tool.  Check here if you are attaching a copy of your (or your spouse if married) tax transcript.  Check here if a tax transcript will be submitted to the school by ______(date).  Check here if you (or your spouse, if married) were not employed and had no income earned from work in 2015.

2. If you (or your spouse, if married) did not file and are not required to file a 2015 Federal income tax return, list below your employer(s) and any income received in 2015 (You must provide the W-2 form or other earnings statements with this form).

Employer’s Name 2015 Amount Earned IRS W-2 Attached? Suzy’s Auto Body Shop (example) $2,000.00 (example) Yes (example)

D. Child Support Paid

If you (or your spouse, if married) paid child support in 2015 complete the following information.

Name of Person Who Paid Name of Person to Whom Name & Age of Child for Annual Amount of Child Child Support Child Support was Paid Whom Support was Paid Support Paid in 2015 Mary Jones Chris Smith (example) Terry Jones – 10 yrs. old $6,000.00

Note: If we have reason to believe that the information regarding the child support paid is not accurate, we may require additional documentation. E. Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps)

Did you or someone in your household receive SNAP in 2014 or 2015? ___ Yes ___ No

Note: If we have reason to believe that the information regarding the receipt of SNAP benefits is inaccurate, we may require documentation for the agency that issued the SNAP benefits in 2014 or 2015

F. Other Untaxed Income______

Payments to tax-deferred pension and retirement savings

List any payments (direct or withheld from earnings) to tax-deferred pension and retirement savings plans (e.g., 401(k) or 403(b) plans), including, but not limited to, amounts reported on W-2 forms in Boxes 12a through 12d with codes D, E, F, G, H, and S.

Name of Person Who Made the Payment Annual Amount Paid in 2015

Child support received

List the actual amount of any child support received in 2015 for the children in your household.

Do not include foster care payments, adoption payments, or any amount that was court-ordered but not actually paid.

Annual Amount of Child Name of Adult Who Name of Child For Whom Support Received in Received the Support Support Was Received 2015 Housing, food, and other living allowances paid to members of the military, clergy, and others

Include cash payments and/or the cash value of benefits received.

Do not include the value of on-base military housing or the value of a basic military allowance for housing.

Annual Amount of Name of Recipient Type of Benefit Received Benefit Received in 2015

Veterans non-education benefits

List the total amount of veterans non-education benefits received in 2015. Include Disability, Death Pension, Dependency and Indemnity Compensation (DIC), and/or VA Educational Work-Study allowances.

Do not include federal veterans educational benefits such as: Montgomery GI Bill, Dependents Education Assistance Program, VEAP Benefits, Post-9/11 GI Bill

Annual Amount of Type of Veterans Name of Recipient Benefit Received in Non-education Benefit 2015

Other untaxed income

List the amount of other untaxed income not reported and not excluded elsewhere on this form. Include untaxed income such as workers’ compensation, disability, Black Lung Benefits, untaxed portions of health savings accounts from IRS Form 1040 Line 25, Railroad Retirement Benefits, etc.

Do not include any items reported or excluded in the above. In addition, do not include student aid, Earned Income Credit, Additional Child Tax Credit, Temporary Assistance to Needy Families (TANF), untaxed Social Security benefits, Supplemental Security Income (SSI), Workforce Investment Act (WIA) educational benefits, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels.

Amount of Other Type of Other Name of Recipient Untaxed Income Untaxed Income Received in 2015 Money received or paid on the student’s behalf

List any money received or paid on the student’s behalf (e.g., payment of student’s bills) and not reported elsewhere on this form. Enter the total amount of cash support the student received in 2015. Include support from a parent whose information was not reported on the student’s 2016–2017 FAFSA. For example, if someone is paying rent, utility bills, etc., for the student or gives cash, gift cards, etc., include the amount of that person's contributions. Amounts paid on the student’s behalf also include any distributions to the student from a 529 plan owned by someone other than the student or the student’s parents, such as grandparents, aunts, and uncles of the student.

Annual Amount Received Source Purpose: e.g., Cash, Rent, Books in 2015

G. Sign this Worksheet

Each person signing this form certifies that all the information reported on it is complete and correct. ______Student’s Signature Date

______Spouse’s Signature Date