Rust College Office of Financial Aid
150 Rust Ave
Holly Springs, MS 38635
(662) 252-8000 ext. 4062 Fax: (662) 252-8895
2011-2012 Dependent Verification Worksheet
Your Free Application for federal Student Aid (FAFSA) was selected for
review in process called “Verification.” All students selected for
verification must submit appropriate documentation to the Rust College
Office of Financial Aid. In this process, your school will be comparing
information from your FAFSA with signed copies of your and your
parent(s)’ 2010 Federal Tax Forms, W-2 form(s), and/or other financial
documents as requested. According to the law, we have the right to ask
for this information before awarding Federal Aid. During your
verification process, Rust College will make any necessary corrections to
your FAFSA. During or after this process, PLEASE DO NOT MAKE
ANY CHANGES TO YOUR FAFSA!!!
Complete and submit the verification worksheet to the Financial Aid
Office as soon as possible to avoid a delay in awarding your financial
aid. If you have questions, you may contact the Financial Aid Office.
What you should do:
1.
2.
3.
4.
Collect your and your parent(s)’ financial
documents (signed Federal Tax forms, W-2
forms, etc.).
Complete and sign the verification
worksheet. You and at least one parent
MUST sign the worksheet.
Submit completed verification worksheet, tax
forms, and any other documents as requested
by the Office of Financial Aid.
Contact the Office of Financial Aid if you
have questions about completing the
verification process.
A. Student Information
_________________________________________ ____________________________________
Last Name
First Name
MI
Student ID
_____________________________________________________________
Student Email Address
______________________________________________________
Student Social Security Number
(_____)_______________________________________________________
Cell Number
(_____)________________________________________________
Parent or Guardian Number
______________________________________________________________
Mailing Address (include Apt. No.)
______________________________________________________
City
ST
Zip
______________________________________________________________
Student Date of Birth
______________________________________________________
Parent’s Email Address
B. Household Information
List the name(s) and age(s) of the people in your parent’s household (as reported on the FAFSA). Please Include:
• Yourself and your parent(s) (including stepparent) even if you don’t live with your parents and
• Your parents’ other children, even if they don’t live with your parent(s), if (a) your parents will
provide more than half of their support from July 1, 2011 through June 30, 2012, or (b) the children
would be required to provide parental information when applying for Federal Student Aid, and
• Other people if they now live with your parents and your parents provide more than half of their
support and will continue to provide more than half of their support from July 1, 2011 through June
30, 2012.
Write the names of all household members in the spaces below. Please include the name of the college for any
household member EXCEPT YOUR PARENT(s), who will be attending at least half time between July 1, 2011
through June 30, 2012, enrolled in a degree or certificate program. Attach separate sheet for more space.
Full Name
Age
Relationship
College Attending (2 year or 4 year colleges only)
Dependent Verification Worksheet
C. Student Income Information
1. Non-Tax Filing Students
Please read carefully and sign one of the following statements.
A. I ____________________________________did not work and are not required to file a tax return for 2010.
Please Print
Signature__________________________________ Date: ________________
B. I ____________________________________did work but are not required to file a tax return for 2010.
Please Print
Signature__________________________________ Date: ________________
You Must Submit W-2 form(s)
2. Tax Filing Students
Please read carefully and sign one of the following statements.
A. I did work and filed a federal tax return for 2010. Attached is a copy of my Federal (1040, 1040A, 1040 EZ)
Income Tax Return along with the W-2 form(s).
Signature__________________________________
Date:
_______________
B. I did work and will be submitting a copy of my Federal Income Tax Return within the next 10 days. I understand
that I will not be awarded Federal Student Aid until all documents have been submitted to your office.
Signature__________________________________
Date: ______________
3. Source of Income Must submit a copy of your 2010 Child Support, TANF, and Social Security Statements.
Sources of Income
Social Security
Child Support
TANF
Amount
$
$
$
D. Parent’s Income Information
1. Tax Filing Parents
Other Source of Income
Parent’s SSN
Amount
$
$
$
Parent’s DOB
Please Read carefully and sign one of the following statements.
A. I did work and filed a federal tax return for 2010. Attached is a copy of my Federal (1040, 1040A, 1040EZ)
Income Tax Return along with W-2 form(s).
Parent’s Signature_________________________________
Date: _______________
B.
I did work and will be submitting a copy of my Federal Income Tax Return within the next 10 days. I understand
that my son/daughter will not be awarded Federal Student Aid until all documents have been submitted to your
office.
Parent’s Signature_________________________________
Date: _______________
2. Non-Tax Filing Parent Must submit a copy of your 2010 Child Support, TANF, and Social Security Statements.
I am unemployed and not required to file a Federal Income Tax Return. I am submitting copies of my 2010 income
statements. I understand that my son/daughter will not be awarded Federal Student Aid until all documents
have been submitted to your office.
Parent’s Signature________________________________ Date: _______________
Source of Income
Amount
Other Source of Income Amount
Social Security
$
$
Child Support
$
$
TANF
$
$
I/we certify that all information reported is complete and correct. I/we understand that no federal aid can be awarded or
disbursed until the verification process is complete.
Student’s Signature___________________________________ Parent’s Signature_________________________________
Date______________
Date_______________