North Central State College
Verification Worksheet - V1-D
Financial Aid Office
2016-2017
Name (print)___________________________________________
NC State I.D.__________________
Your parent’s family – Name ALL persons in your parents’ family
Your parents’ family includes: You even if you don’t live with your parents, your parent/s (custodial parent if
separated/divorced), your step-parent (if married to your custodial parent), your parents’ other children (if
your parents provide the majority of their financial support, and your parents do not pay child support for them),
and other family members (if your parents financially support them, and they live with your parents 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
Food Stamps (SNAP)
Did anyone in your parents’ 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 parents 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 in
2015 for child
$
$
$
$
Required:
Provide the Financial Aid Office with a printout from the Child Support Enforcement Agency which
verifies the amount of child support paid or received from January 1, 2015 through December 31, 2015.
OVER
Income Tax Information – Student
#1S – Did (or will) the student file a 2015 Federal Tax Return?
□
Yes – Go to #2S below.
□ No – Go to the Income Tax Information-Parent section below.
#2S – How did the student enter tax information on the FAFSA?
□
□
Electronically using the IRS Data Retrieval Tool.
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 Income Tax Information-Parent section 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
Income Tax Information – Parent
#1P – Did (or will) parent/s file a 2015 Federal Tax Return?
□
Yes – Go to #2P below.
□ No – Go to the Non-Filers section below.
#2P – How did parent/s enter tax information on the FAFSA?
□
□
Electronically using the IRS Data Retrieval Tool.
Manually. Submit Tax Return Transcript/s with this worksheet.
If both student and parent/s filed 2015 Federal Tax Returns, go to the Certification Statement below.
Non-Filers – For those NOT filing a 2015 Federal Tax Return
A. Did the student work and earn wages in 2015?
B. Did parent/s work and earn wages in 2015?
□
No
□ Yes
□ No □ Yes
If “no” to both A and B, go to the Certification Statement below.
If “yes” to either A or B, for the person/s who worked but did not file taxes: Submit a copy of all W-2 forms received and
complete the following:
Student or parent
Name of employer
Amount earned in 2015
$
$
$
$
Certification Statement
By signing here, I certify that all information being reported to qualify the student 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 the student for federal student aid, I may be fined, be sentenced to jail, or both.
Student Signature___________________________________________
Date______________________
Parent 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