North Central State College
Verification worksheet - v1-i
Financial Aid Office
2016-2017
Name (print)_________________________________________
NC State I.D.____________________
Your family – Name ALL persons in your family
Your family includes: You, your spouse (if married), your children (if you or your spouse provide the
majority of their financial support, and you or your spouse do not pay child support for them), and other
family members (if you of your spouse financially support them, and they live with you now and will
continue to do so until June 30, 2017).
First & Last Name
Age
Relationship to You
Self
College Attending in 2016-2017 if any
North Central State College
SNAP (Food Stamps)
Did anyone in your family (those listed above) receive SNAP benefits in either 2014 or 2015?
□
No
□
Yes
Required if Yes:
Provide the Financial Aid Office with documentation from Jobs & Family Services
which verifies that SNAP benefits were received in either 2014 or 2015 (not 2016).
Child Support – Paid or Received
Did you or your spouse pay or receive child support in 2015?
If yes, complete to following:
Name of person who paid
Name of person
receiving payment
□
No
□
Yes
Name of child for whom
support was paid
Amount paid or
received in
2015 for child
$
$
$
$
Required:
Provide the Financial Aid Office with a printout from your Child Support Enforcement Agency
which verifies the child support paid or received from January 1, 2015 through December 31, 2015.
OVER
V1-I
Name (print) _________________________ I.D. _______________
Income Tax Information
#1 – Did (or will) you (and/or your spouse) file a 2015 Federal Tax Return?
□
□
Yes
Go to #2 below.
No
Go to #3 below.
#2 – How did you enter tax information on the FAFSA?
□
□
Electronically using the IRS Data Retrieval Tool. Enter date DRT used: ________________________
• Even after a FAFSA has been processed, the DRT can be used by submitting a correction to the
FAFSA.
Go to the Certification Statement below.
Manually. Submit with this worksheet:
Tax Return Transcript/s. A transcript is a printout of your tax return information provided by the IRS.
Note that:
•
A copy of your tax return cannot be used.
•
An IRS Account Transcript is not acceptable, only a Return Transcript may be used.
•
If you filed taxes as “Married Filing Jointly” but are now separated or divorced, copies of your
2015 W-2 forms are also required.
Transcripts may be obtained from the IRS at:
• www.irs.gov
• The IRS office at 180 N. Diamond St. in Mansfield (in the main post office building)
• 1-800-908-9946
Go to the Certification Statement below.
#3 – For those NOT filing a 2015 Federal Income Tax Return
A. Did you work and earn wages in 2015?
□
No
B. Did your spouse work and earn wages in 2015?
□ Yes
□ N/A (not married) □ No □ Yes
If “no” or “N/A” to both 3A and 3B, go to the Certification Statement below.
If “yes” to either 3A or 3B, submit a copy of all W-2 forms received and complete the following:
Student or spouse
Name of employer
Amount earned in 2015
$
$
$
$
Certification Statement
By signing here, I certify that all information being reported to qualify me for federal student aid is true and complete
to the best of my knowledge. I understand that if I purposely give, or knowingly allow others to give, false or
misleading information to qualify me for federal student aid, I may be fined, be sentenced to jail, or both.
Student Signature___________________________________________ Date______________________
143 Byron Kee Hall ♦ 2441 Kenwood Circle • Mansfield, Ohio 44906 ♦ 419-755-4899 (voice) • 419-755-4729 (fax)
[email protected] ♦ http://www.ncstatecollege.edu/cms/financial-aid.html