Independent
2016‐2017 Verification Worksheet
Federal Student Aid Programs
U.S. Department
of Education
Your application was selected for review in a process called “Verification.” During this process, St. Joseph’s College
(SJC) will be comparing information from your FAFSA application with copies of your and/or your spouse’s 2015
Federal tax forms, W-2 forms, and possibly other necessary financial documents. The law specifies we reserve the
right to request this information before awarding any Federal or Institutional funds. If there are any discrepancies
found between your FAFSA application information and your financial documents, your FAFSA may need to be
corrected.
Submit this information to the Office of Financial Aid immediately, as we will not typically award Federal and/or
institutional awards until this process is complete. Failure to complete verification in a timely manner may lead to
cancellation of aid. Should additional information be required, the Office of Financial Aid will contact you quickly.
You will always be notified if FAFSA corrections result in changes/cancellation of award(s).

Submit the completed 2016-2017 Independent Verification Worksheet. Make sure the form is signed. This
form needs to be filled out completely; if the answer is zero write “0”, do not leave blank.

If the number in household and/or college you are reporting now on the Verification Worksheet does not
match the number(s) you reported on the FAFSA, submit a written explanation of the discrepancy which must
be signed by the student.

Submit 2015 Federal Tax Transcript(s) and W-2 forms for both student and/or spouse, if filed. As per federal
regulations, we can no longer accept copies of the filed federal tax return unless it is specifically requested by
the Office of Financial Aid.



You can obtain a Federal Tax Return Transcript by calling the IRS at 1-800-908-9946 or online at
www.irs.gov. If ordering online, click on the “Order a Return or Account Transcript” link. Make
sure to request the “IRS Tax Return Transcript” and not the “IRS Account Transcript”. Use the
Social Security Number and date of birth of the first person listed on the 2015 IRS income tax
return, and the address on file with the IRS (make sure that the address is typed exactly as
shown on the 2015 IRS income tax return).
To use the IRS Data Retrieval Tool (IRS DRT) via FAFSA on the Web to verify your income tax
information: In most cases the IRS DRT is available within 2-3 weeks after the 2015 electronic IRS
income tax return has been accepted by the IRS or 8-11 weeks after the 2015 paper IRS income
tax return has been accepted by the IRS. Contact the financial aid office if more information is
needed about using the IRS DRT.
If you prefer to order a tax return transcript, in most cases for electronic filers, a 2015 Tax Return
Transcript may be requested from the IRS within 2-3 weeks after the 2015 IRS income tax return
has been accepted by the IRS. Generally, for filers of 2015 paper IRS income tax returns, the 2015
IRS Tax Return Transcript may be requested within 8-11 weeks after the 2015 paper IRS income
tax return has been received by the IRS.
Return the completed worksheet to the campus you attend:
St. Joseph’s College Attn: Office of Financial Aid
Long Island Campus
155 West Roe Boulevard
Patchogue, NY 11772
FAX: 631-650-2525
PHONE: 631-687-2600
Brooklyn Campus
245 Clinton Avenue
Brooklyn, NY 11205
FAX: 718-636-6827
PHONE: 718-940-5700
Independent
2016‐2017 Verification Worksheet
Federal Student Aid Programs
Student Information
Last Name
First Name
M.I.
SJC ID/ Social Security Number
Address (include Apt. #)
City
Date of Birth
State
Zip Code
Phone Number (Include Area Code)
Family Information
In the space(s) below, list the people in your household including:
 Yourself and/or your spouse (if applicable)
 Your children, if you will provide more than half of their support from July 1, 2016 through June
30, 2017 (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.
 Write in the name of the college for any household member who will be attending at least half
time between July 1, 2016 and June 30, 2017, and will be enrolled in a degree, diploma, or
certificate program. If you need more space, attach a separate page.
Full Name
Yes
No
Age
Relationship
Self
College
St. Joseph’s College
Did you or someone in your household as indicated above, receive SNAP benefits
in 2015 or 2016? If yes, please identify which family member here______________________
and submit supporting documentation to verify receipt, such as a copy of the SNAP benefits
card.
Please continue to next page
1
SJC ID/Student’s Name:_________________________________________________________________
Independent
Student (and Spouse) Tax Forms and Income Information
Check the box that best describes your filing status for 2015:
 The student was not employed and had no income earned from work in 2015.
 The student was employed in 2015 and has listed the names of all employers in the box below, the
amount earned from each employer in 2015, and whether an IRS W-2 form is provided.
 The student filed a 2015 Federal Tax Return and has used the IRS DRT in the FAFSA on the Web to
transfer 2015 IRS income tax return information into the students FAFSA. A copy of the student W-2
is attached.
 The student filed a 2015 Federal Tax Return and has not yet used the IRS DRT in FAFSA on the Web,
but will use the tool to transfer 2015 IRS income tax return information into the student’s FAFSA once
the 2015 IRS income tax return has been filed. A copy of the student W-2 is attached.
 The student filed a 2015 Federal Tax Return and is unable or chooses not to use the IRS DRT in FAFSA
on the Web, and instead will provide the school with a 2015 IRS Tax Return Transcript(s). A copy of
the student W-2 is attached.
___ Check here if a 2015 IRS Tax Return Transcript(s) is provided.
___ Check here if a 2015 IRS Tax Return Transcript(s) will be provided later.
Employer’s Name
Suzy’s Auto Body Shop (example)
Amount Earned
$2,000
IRS W-2 Provided?
Yes
Additional Financial Information and Untaxed Income
Use the tables on the next page to report annual (not monthly) amounts as indicated on your 2015 TAX RETURN.
Tax returns include the 2015 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico, or a foreign tax return.
If the amount is zero, write “0”, do not leave blank.
2015 Additional Financial Information
a.
b.
c.
d.
e.
f.
Education Credits (Hope and Lifetime Learning tax credits) from IRS Form
1040 –line 50 or 1040A – line 33
Child support paid because of divorce or separation or as a result of legal
requirement. You must supply a statement from the payer of the child support
indicating the annual amount of support and the names of the children for which
the funds are being paid. (The statement must be signed by both the payer and
SJC student.)
Taxable earnings from need-based employment programs, such as Federal WorkStudy and need-based employment portions of fellowships and assistantships
Grant and scholarship aid reported to the IRS in your adjusted gross income.
Includes AmeriCorps benefits (awards, living allowances, and interest accrual
payments), as well as grant and scholarship portions of fellowships and
assistantships.
Combat pay or special combat pay. Only enter the amount that was taxable and
included in your adjusted gross income.
Earnings from work under a cooperative education program offered by a college
(do not include earnings from any SJC work program).
STUDENT/SPOUSE
$
$
$
$
$
$
Please continue to next page
2
SJC ID/Student’s Name:_________________________________________________________________
Independent
2015 Untaxed Income
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Yes
STUDENT/SPOUSE
Payments to tax-deferred pension and savings plans (paid directly or withheld
from earnings) including, but not limited to, amounts reported on the W-2 forms in
Boxes 12a through 12d: codes D, E, F, G, H, and S. (Must submit W-2)
IRA deductions and payments to self-employed SEP, SIMPLE, Keogh and other
qualified plans from IRS Form 1040 – line 28 + line 32 or 1040A- line 17.
Child support received for all children in your household.
(Don’t include foster care or adoption payments)
Tax exempt interest income from IRS Form 1040 – line 8b or 1040A – line 8b
Untaxed portions of IRA distributions from IRS Form 1040 –lines 15a minus 15b or
1040A – lines 11a minus 11b. Exclude rollovers. (Must submit 1099R)
Untaxed portions of pensions from IRS Form 1040 lines 16a minus 16b or 1040A
lines 12a minus 12b. Exclude rollovers. If negative, enter “0”. (Must submit
1099R).
Housing, food, and other living allowances paid to members of the military, clergy,
and others (including cash payments and cash value of benefits).
Veterans’ non-education benefits such as Disability Death Pension or Dependency
& Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances.
Other untaxed income not reported elsewhere on this form, such as workers’
compensation, disability, etc. Also include the first-time homebuyers tax credit
from IRS form 1040, line 67.
Do not include student aid, earned income credit, child tax credit, welfare
payments, untaxed Social Security benefits, Workforce Investment Act educational
benefits, combat pay, (if you are not a tax filer), benefits from flexible spending
arrangements (e.g. cafeteria plans), foreign income exclusion or credit for federal
tax on special fuels.
Money received or paid on your behalf (e.g. bills), not reported elsewhere on this
form.
No
$
$
$
$
$
$
$
$
$
$
Were you (your household) supported in 2015 by any of the following income?
Untaxed student financial aid, welfare, any kind of Social Security benefits, Workforce Investment Act
educational benefits, combat pay (if you are not a tax filer), benefits from flexible spending arrangements (e.g.
cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels (Do not include income
already reported somewhere else on this form).
Sign this Worksheet
Each person signing this form certifies that all the information reported on it is complete and correct. The student
must sign and date.
Student
Date
Spouse
Date
WARNING: If you purposely give
false or misleading information on
this worksheet, you may be fined, be
sentenced to jail, or both.
3
SJC ID/Student’s Name:_________________________________________________________________