2016-2017 VERIFICATION FORM 6
FORM 6
North Central Michigan College
Independent (V5)
Your 2016-17 Free Application for Federal Student Aid
(FAFSA) was selected for review in a process called
“Verification”. The law says that before awarding Federal
Student Aid, we may ask you to confirm information you
reported on your FAFSA. To verify that you provided correct
information, the Financial Aid Office will compare your FAFSA
with the information on this worksheet and any other required
documents. If there are differences, your FAFSA information
will be corrected. You must complete and sign this worksheet,
attach any required documents, and submit them to NCMC’s
Financial Aid office. We may ask for additional information.
Submit to:
North Central Michigan College
Financial Aid Office
1515 Howard Street
Petoskey, MI 49770
FAX: 231-348-6627 OR 231-348-6685
EMAIL: [email protected] OR [email protected]
*TAX INFORMATION INSTRUCTIONS*
1. It is strongly recommended that you select the IRS Data
Retrieval option on your FAFSA. This option will
streamline and expedite the processing of your verification.
(To use the IRS Data Retrieval Tool go to www.fafsa.gov,
log in to your FAFSA, select “Make FAFSA Corrections”
and navigate to the Financial Information section.
If you choose not to use (or are not eligible to use) the IRS
Data Retrieval Tool, you will need to submit an IRS Tax
Return Transcript. (Transcripts must be requested
directly from the IRS by visiting www.IRS.gov > Get
Transcript of Tax Record > Get Transcript Online or by
calling 1-800-908-9946. )
2. Complete and sign the worksheet.
3. Submit the completed worksheet, tax forms, and any other
documents requested to North Central Michigan College,
Financial Aid Office.
A. Student Information
_____________________________________________
Last Name
First Name
________________________________________________
Social Security Number
OR
NCMC Student ID#
M.I.
________________________________________________________
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, including:
 Yourself, and your spouse if you are married, and;
 Your children, if you will provide more than half of their support from July 1, 2016, through June 30, 2017; or if the child is
required to provide your information on their 2016-17 FAFSA. 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 from July 1, 2016 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 educational institution between July 1, 2016 and June 30, 2017. If you need more space, attach a separate
piece of paper with the student’s name on the top.
Full Name
Age
Relationship
College
Martha Jones (example)
24
Wife
City University
Self
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C. Student ( Spouse, if applicable) Tax Forms and Income Information
Independent (V5)
1. Check only one box below:
Check here if you completed the IRS Data Retrieval when submitting your FAFSA or have updated your FAFSA using the
IRS Data Retrieval Tool.
Check here if you are attaching a copy of your 2015 IRS Tax Transcript. (Copies of Tax Returns are not accepted.)
See Page 1. **TAX INFORMATION INSTRUCTIONS** for obtaining an IRS Tax Return Transcript.
** If You and Spouse filed “Separately” a Tax Transcript for each person needs to be submitted.
Check here if you and your spouse (if applicable) will not file and are not required to file a 2015 U.S. Income Tax Return. If
asked by the school I will provide a “Verification of Non-Filing Letter” from the IRS. (Available at www.IRS/gov after
June 15, 2016.) If you or your spouse were employed and did not file taxes, please fill in the information below.
**If you/spouse DID NOT file taxes, a copy of all 2015 IRS W-2s issued to you/spouse MUST be provided.
2015 IRS W-2 Included?
2015 Employer’s Name
2015 Annual Amount Earned
(YES/NO)
Suzy’s Auto Shop (example )
$2000.00 (example)
Yes
D. Other Information to be Verified
1. SNAP (Food Stamps):

Check here if someone in your household (listed in Section B of this worksheet) reported on FAFSA, the receipt of Supplemental
Nutrition Assistance Program or SNAP (food stamps) any time during the 2014 and/or 2015 calendar years.
If asked by the school, I will provide documentation of the receipt of SNAP benefits.
2. Funds paid for child support:
If you, or if married, your spouse who is listed in Section B of this worksheet reported on the FAFSA child support paid in 2015,
please complete the following information. If asked by the school, I will provide documentation of the payment of child support.
If you need more space, attach a separate page with the Student’s name at the top.
Name of Person who Paid Child
Support
Name of Person to Whom Child
Support Was Paid
Name of Child for Whom
Support Was Paid
Amount of
child support
paid for 2015
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E. High School Completion Status
Please check only one box below to indicate the documentation you are providing to verify high school completion status:

I am providing a copy of the student’s high school diploma.
I am providing a copy of the student’s final official high school transcript that shows the date the diploma was awarded.
I am providing a copy of the student’s General Educational Development (GED) certificate; or official GED transcript.
I am providing a copy of the student’s official home school completion credential.
I am providing a copy an academic transcript that indicates the student successfully completed at least a two-year
program that is acceptable for full credit toward a bachelor’s degree.
I am providing a copy of a DD Form 214 Certificate of Release or Discharge From Active Duty that indicates
completion of high school or equivalent.
Please contact the financial aid office if you are unable to obtain the documentation listed above.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
F. Identity and Statement of Educational Purpose
** THIS SECTION MUST BE COMPLETED AT NORTH CENTRAL MICHIGAN COLLEGE IN THE
PRESENCE OF AN INSTITUTIONAL OFFICIAL **
Student must appear IN PERSON at North Central Michigan College to verify his/her identity by presenting a
valid government-issued photo identification (ID), such as, but not limited to: a driver’s license; other state-issued
ID; or passport. The institution will maintain a copy of the student’s photo ID that is annotated with the date it was
received and the name of the official at the institution authorized to collect the student’s ID.
IN ADDITION, the student must sign, in the presence of the institutional official, the following:
STATEMENT OF EDUCATIONAL PURPOSE
I certify that I, ______________________________________________, am the individual signing this Statement of
(Print Student’s Full Name)
Educational Purpose and that the federal student financial assistance I may receive will only be used for
educational purposes and to pay the cost of attending North Central Michigan College for 2016-2017.
____________________________
(Student’s Signature)
______________________________
(Student’s North Central ID#)
___________________
(Date)
SECTION BELOW TO BE COMPLETED BY INSTITUTIONAL OFFICIAL ONLY
A copy of the ID presented by the above student is attached (REQUIRED)
____________________________________
(School Official Signature)
________________________________
(Print Name)
______________
(Date)
G. Signature and Certification
Each person signing this form certifies that all the information reported is complete and correct.
__________________________________________________________
_________________________________________________________
Student (required)
Spouse (optional)
Date
Date
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
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