Dependent Student V1

2016-17 Verification Worksheet

Dependent Student –V1

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 and your parents 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 and at least one parent 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 parent(s)’ household. Include:

 Yourself and your parent(s) (including a stepparent) even if you do not live with your parent(s).  Your parents(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2016, through June 30, 2017, or if the other children would be required to provide parental 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 your parent(s).  Other people if they now live with your parent(s) and your parent(s) 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, excluding your parent(s), who will be enrolled, at least half time in a degree, diploma, or certificate program at an eligible postsecondary education 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 Sister Central University Yes Self TAX RETURN FILERS – Important Note: If the student and or parent(s) 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 sections C and D.

Instructions: Complete these sections if the student and or parent(s), 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 the student has not already used the tool, go to FAFSA.gov, log in to the student’s FAFSA record, select “Make FAFSA Corrections,” and navigate to the Financial Information section of the form. From there, follow the instructions to determine if the student is 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 tax transcript.  Check here if a tax transcript will be submitted to the school or will be using the IRS Data Retrieval Tool  Check here if you were not employed and had no income earned from work in 2015.

2. If you 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. Parent(s)’ Tax Forms and Income Information

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

2. If your parents did not file and are not required to file a 2015 Federal income tax return, list below 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) E. Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps)

Did you or someone in your parent’s 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 from the agency that issued the SNAP benefits in 2014 or 2015.

F. Child Support Paid

If one of the parents included in the household of the student paid child support in 2015 complete the following.

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 child support paid is not accurate, we may require additional documentation.

G. Sign this Worksheet

Each person signing this form certifies that all the information reported on it is complete and correct. The student and one ______parent whose information was reported on the FAFSA Student’s Signature Date must sign and date.

______Parent’s Signature Date