2017-2018 Non-Filer Verification of Income
Financial Aid Office, 1637 Lawson Street, Durham NC 27703
Phone 919-536-7209, Fax 919-686-3672
Your 2017-2018 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 the information
you reported on your FAFSA. To verify that you provided correct information, your FAFSA information will be
compared with the information on this worksheet and any other required documents. If there are differences,
your FAFSA information may need to be corrected. You must complete and sign this worksheet, attach any
required documents, and submit them to the Financial Aid office at Durham Tech. Durham Tech may ask for
additional information as required. If you have questions about verification, contact the Financial Aid office.
A. Student Information
Name
Address
Date of Birth
Student ID or Social
Security Number
Cell Phone Number
Durham Tech Email
(ConnectMail)
B. Student Income Information
If you did not, will not, and are not required to file a 2015 federal tax return, complete the following
statements of non-filing and itemization of income from employment (not Work-Study) for yourself.
☐ I certify that I was employed and I had income earned from work in 2015 but I was not required to
complete a 2015 Federal IRS 1040, 1040A, 1040EZ, a tax return for Puerto Rico, or for a foreign country.
Copies of all of my W-2 forms are attached to this document, and a Verification of Non-Filer Letter.
☐ I certify that I was not employed and I had no income earned from work in 2015, and I was not required
to complete a 2015 Federal IRS1040, 1040A, 1040EZ, a tax return for Puerto Rico, or for a foreign country.
Employer’s Name
(Ex.) ABC’s Auto Body Shop
IRS W-2 Provided?
Yes
Annual Amount Earned in 2015
$4,500.00
Total Income Earned from Work $_______________
Revised 04/27/2017, page 1
C. Parent or Spouse Non-Filer Income Information
If the parent (of dependent student) or spouse (of independent student) did not, will not, and are not
required to file a 2015 federal tax return, complete the following statements of non-filing and itemization
of income from employment (not Work-Study) .
☐ I certify that I (the parent or spouse) was employed, I had income earned from work in 2015, but I was
not required to complete a 2015 Federal IRS 1040, 1040A, 1040EZ, a tax return for Puerto Rico, or for a
foreign country. Copies of all of my W-2 forms are attached to this document, and a Verification of NonFiler Letter.
☐ I certify that I (the parent or spouse) was not employed, I had no income earned from work in 2015, and
I was not required to complete a 2015 Federal IRS1040, 1040A, 1040EZ, a tax return for Puerto Rico, or for
a foreign country.
Employer’s Name
(Ex.) ABC’s Auto Body Shop
IRS W-2 Provided?
Yes
Annual Amount Earned in 2015
$4,500.00
Total Income Earned from Work $_______________
Please explain how you maintained your household and met your living expenses in 2015.
_________________________________________________________________________________________
_________________________________________________________________________________________
D. Certification
I certify that all the information reported on this worksheet is complete and correct. The student must sign
this worksheet. If married, the spouse’s signature is optional. Warning: If you purposely give false or
misleading information, you may be fined, sentenced to jail, or both.
Student Signature
Parent or Spouse Signature
Date
Date
Revised 04/27/2017, page 2