2011-2012
Verification Worksheet
The federal government requires colleges to compare the information from your Free Application for Federal Student Aid (FAFSA) with the information
you provide on this form along with signed copies of 2010 Federal tax forms and W-2’s. This process is called “Verification”. We must verify your
information before your financial aid can be finalized. Your aid may be adjusted based on the Verification process.
A. Student’s Name (Print) ________________________________ Student’s ID#/SS# ______________________________
Date of Birth ____________________________________ Phone _______________________________________
Family Information
DEPENDENT Students: Complete the table below using the following
instructions about the people your parents will support between
July 1, 2011 and June 30, 2012.
Include:
• yourself
• your parent(s) (include stepparent that you live with)
• your parent(s)’ other children, even if they don’t live with your
parent(s) but your parent(s) will provide more than half of their support.
Include other people:
• if they now live with your parent(s), and your parent(s) provides more
than half of their support, and your parent(s) will continue to provide
more than half of their support.
Also include college information for those who will attend at least half-time
and will be enrolled in a degree or certificate program. If you need more space,
attach a separate page.
B. Full Name of Family Members
(list yourself here)
Age
INDEPENDENT Students: Complete the table below using the
following instructions about the people you will support
between July 1, 2011 and June 30, 2012.
Include:
• yourself
• your spouse (if married)
• your children (stepchildren), if you will provide more
than half of their support
Include other people:
• if they now live with you, you provide more than half of
their support, and you will continue to provide more
than half of their support.
Also include college information for those who will attend at
least half-time and will be enrolled in a degree or certificate
program. If you need more space, attach a separate page.
Relationship
Full Name of College if Attending in 2011-12
(Do not abbreviate, and please include city & state)
Self
Tax Return Information
• All tax filers must submit a SIGNED copy of their 2010 Federal Income Tax Return, W-2’s and form 1099’s. Acceptable tax returns include: 2010 IRS Forms 1040, 1040A,
1040EZ, a tax return from Puerto Rico or a foreign income tax return must be converted into US dollars. Do not submit state tax returns.
PLEASE NOTE: IRS FORMS 8453 and 8879 are NOT acceptable forms.
• If you or your parent/stepparent filed a 2010 Federal Tax Return but did not keep a copy, you can obtain a copy from your tax preparer or request a transcript
summary and W-2(s) from the IRS at 1-800-829-1040. You may also log onto www.irs.gov to download Form 4506T (Request for Transcript of Tax Return).
*Transcript summaries must be SIGNED by the taxpayer. If you filed an amended return, you must submit it along with a copy of the original SIGNED federal tax return.
C. Student’s Tax Forms and Income Information (all applicants)
1. Check only one box below. Tax returns include the 2010 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico or a foreign income tax return.
If you did not keep a copy of your tax return, request a copy from your tax preparer or request an IRS form that lists tax account information.
Check here if you are attaching a signed copy of your tax return.
Check here if a signed tax return will be submitted to the school by ______________________ (date).
Check here if you will not file and are not required to file a 2010 U.S. income tax return.
2. Funds received for child support and other untaxed income. (see question 47 of the FAFSA)
Sources of Untaxed Income
a. Child Support
b. Workman’s Comp
c. Untaxed Pensions
2010 Amount
$
$
$
Sources of Untaxed Income
d.
e.
f.
2010 Amount
$
$
$
3. If you did not file and are not required to file a 2010 federal income tax return, list below your employer(s) and any income received in 2010
(use the W-2 form or other earnings statement if available).
Sources
2010 Income
$
$
$
D. Parent(s)’ or Spouse’s (if married) Tax Forms and Income Information
1. Check only one box below. Tax returns include the 2010 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico or a foreign income tax return.
If you did not keep a copy of your tax return, request a copy from your tax preparer or request an IRS form that lists tax account information.
Check here if you are attaching a signed copy of your tax return.
Check here if a signed tax return will be submitted to the school by ______________________ (date).
Check here if you will not file and are not required to file a 2010 U.S. income tax return.
2. Funds received for child support and other untaxed income. (see question 47 of the FAFSA)
Sources of Untaxed Income
a. Child Support
b. Workman’s Comp
c. Untaxed Pensions
2010 Amount
$
$
$
Sources of Untaxed Income
d.
e.
f.
2010 Amount
$
$
$
3. If you did not file and are not required to file a 2010 federal income tax return, list below your employer(s) and any income received in 2010
(use the W-2 form or other earnings statement if available).
Sources
2010 Income
$
$
$
E. Sign this worksheet
Each person signing this form certifies that all the information reported is complete and correct. The student and a least one parent must sign and
date if student is considered dependent. If the student is independent, only the student’s signature is required.
_____________________________________________
Student
Date
_____________________________________________
Parent
Date
WARNING: If you purposely provide false or misleading information
on this worksheet, you may be fined, sentenced to jail or both.