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__________________________
UH ID Number/Username
2015-2016 Verification Worksheet
Federal Student Aid Programs
Last Name
First Name
M. I.
(____)________________________
Phone Number (include area code)
Your application for federal financial aid was selected for review in a process called “Verification.” In the process, we will be
comparing information from your FAFSA application with your Federal tax information, W-2 forms and/or other financial
documents. The law says we must ask you for this information before awarding financial aid. If there are differences between your
application information and your financial documents, corrections will be made to your application and your information will be
reprocessed.
You must complete and sign this worksheet and submit it along with any documents requested below. We cannot continue
processing your financial aid application until verification has been completed.
You should complete verification as soon as possible so that your financial aid won’t be delayed. Contact the Financial Aid Office at
(808) 932-7449 if you need assistance.
A. FAMILY INFORMATION
DEPENDENT STUDENTS: List the people in your parents’ household; include the following:
• yourself and your parent(s) you live with (including stepparent), and
• your parents’ other children, if (a) your parents provide more than half of their support from July 1, 2015 through June 30,
2016, 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, 2015 through June 30, 2016.
INDEPENDENT STUDENTS: List people in your household; include the following:
• yourself and your spouse, if married,
• your children, if you provide more than half of their support from July 1, 2015 through June 30, 2016, and
• 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, 2015 to June 30, 2016.
Write the names of all family members. Also write in the name of the college for any family member, excluding your
parent(s), who will be attending college at least half-time between July 1, 2015 and June 30, 2016, and will be enrolled in a
degree, diploma, or certificate program. If you need more space, attach a separate page.
Full Name
Age
Relationship
College
Self
University of Hawaii at Hilo
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B. STUDENT’S INCOME INFORMATION TO BE VERIFIED – Complete Section B1, B2 OR B3.
B1 - U.S. TAX RETURN FILERS— Complete this section if you the student (and/or your spouse if married), filed or will file
a 2014 income tax return with the IRS. The best way to verify income is by using the IRS Data Retrieval Tool that is part of FAFSA on
the Web. If you need more information about when, or how to use the IRS Data Retrieval Tool, please contact the Financial Aid Office.
Check the box that applies:
I, the student (and, if married, my spouse):
have used the IRS Data Retrieval Tool to transfer my 2014 IRS income information into my FAFSA, either on the initial
FAFSA or when making a correction. The Financial Aid Office will use the IRS information transferred to complete the
verification process.
have not yet used the IRS Data Retrieval Tool, but will transfer my 2014 IRS income information into my FAFSA once my
IRS tax return has been filed. The Financial Aid Office cannot complete the verification process until we have received an
updated FAFSA confirming that your IRS income information has been transferred.
am unable or choose not to use the IRS Data Retrieval Tool, and will submit to the school my 2014 IRS tax return
transcript(s)—not photocopies of the income tax return. To obtain an IRS tax return transcript, go to www.IRS.gov and click
on the “Get a Transcript of Your Tax Records” link under “Tools”, or call 1-800-908-9946. If you are married and you and
your spouse filed separate 2014 tax returns, you must submit tax return transcripts for both you and your spouse.
Check here if an IRS tax return transcript(s) is attached to this worksheet.
Check here if IRS tax return transcript(s) will be submitted to your Financial Aid Office later. Verification cannot be
completed until the IRS tax return transcript(s) has been submitted to your Financial Aid Office.
B2 – U.S. TAX RETURN NON-FILERS - Complete this section if you, the student (and, if married, your spouse), will not
file and are not required to file a 2014 income tax return with the IRS.
Check the box that applies:
I, the student (and, if married, my spouse):
was not employed and earned no income from work in 2014.
was employed in 2014 and have listed below the names of all employers and the amount earned from each employer in 2014.
Please attach copies of all 2014 W-2 forms issued to you and/or your spouse by employers.
List every employer even if the employer did not issue an IRS W-2 form. If more space is needed, attach a separate page with
your name and ID number at the top.
Employer’s Name
2014 Amount Earned
B3 – FOREIGN, U.S. TERRITORY OR FREELY ASSOCIATED STATES TAX RETURN FILERS OR
NON-FILERS
Check the box that applies:
I, the student (and, if married, my spouse):
was not employed and earned no income from work in 2014.
have completed a 2014 foreign/U.S. Territory tax return or received a wage & tax statement from one of
the Freely Associated States. In 2014 I/we received $_______________ (USD) in wages/income and
paid $__________ (USD) in taxes.
You must submit a signed copy of the tax return or wage & tax statement.
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C. PARENT’S INCOME INFORMATION TO BE VERIFIED (To be completed by the PARENT if
parent information was required on the FAFSA) – Complete Section C1, C2 OR C3.
Note: If two parents were reported in Section A of this worksheet, the instructions and certifications below refer and apply to both
parents.
C1 - U.S. TAX RETURN FILERS— Complete this section if you, the student’s parent(s) filed or will file a 2014 income tax
return with the IRS. The best way to verify income is by using the IRS Data Retrieval Tool that is part of FAFSA on the Web. If you
need more information about when, or how to use the IRS Data Retrieval Tool, please contact the Financial Aid Office.
Check the box that applies:
I/we, the parent(s):
have used the IRS Data Retrieval Tool to transfer 2014 IRS income information into the student’s FAFSA, either on the
initial FAFSA or when making a correction. The student’s school will use the IRS information transferred into the student’s
FAFSA to complete the verification process.
have not yet used the IRS Data Retrieval Tool, but will transfer 2014 IRS income information into the student’s FAFSA once
an IRS tax return has been filed. The Financial Aid Office cannot complete the verification process until we have received an
updated FAFSA confirming that your IRS income information has been transferred.
am/are unable or choose not to use the IRS Data Retrieval Tool, and will submit to the school a copy of my/our 2014 IRS tax
return transcript(s)—not photocopies of the income tax return. To obtain an IRS tax return transcript go to www.IRS.gov and
click on the “Get a Transcript of Your Tax Records” link under “Tools”, or call 1-800-908-9946. If you are married and you
and your spouse filed separate 2014 tax returns, you must submit tax return transcripts for both you and your spouse.
Check here if an IRS tax return transcript(s) is attached to this worksheet.
Check here if IRS tax return transcript(s) will be submitted to the student’s Financial Aid Office later. Verification
cannot be completed until the IRS tax return transcript(s) has been submitted to the Financial Aid Office.
C2 – U.S. TAX RETURN NON-FILERS - Complete this section if you, the student’s parents, will not file and are not
required to file a 2014 income tax return with the IRS.
Check the box that applies:
I/we, the parent(s):
was not employed and earned no income from work in 2014.
was employed in 2014 and have listed below the names of all employers and the amount earned from each employer in 2014.
Please attach copies of all 2014 W-2 forms issued to you by employers.
List every employer even if the employer did not issue an IRS W-2 form. If more space is needed, attach a separate page with
your name and ID number at the top.
Employer’s Name
2014 Amount Earned
C3 – FOREIGN, U.S. TERRITORY OR FREELY ASSOCIATED STATES TAX RETURN FILERS OR
NON FILERS
Check the box that applies:
I/we, the parent(s):
was not employed and earned no income from work in 2014.
have completed a 2014 foreign/U.S. Territory tax return or received a wage & tax statement from one of
the Freely Associated States. In 2014 I/we received $_______________ (USD) in wages/income and
paid $__________ (USD) in taxes.
You must submit a signed copy of the tax return or wage & tax statement.
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D. OTHER INFORMATION TO BE VERIFIED
a.
Did you (or your spouse, if married) and/or your parent(s) pay child support in 2014?
Yes
No
If yes, indicate below the name of the person who paid the child support, the name of the person to whom the child support was
paid, the names of the children for whom child support was paid, and the total annual amount of the child support that was paid in
2014 for each child. Do not include child support paid for children listed in Section A of this worksheet.
Name of Person Who Paid
Child Support
b.
Name of Person to Whom
Child Support was Paid
Name of Child for Whom
Support Was Paid
Age of
Child
Amount of Child
Support Paid in
2014
Did someone in your household (listed in Section A) receive benefits from the Supplemental Nutrition Assistance Program or
SNAP (formerly known as food stamps) any time during 2013 or 2014?
Yes
No
E. SIGN THIS WORKSHEET
By signing this worksheet, I/we certify that all the information reported to qualify for Federal student aid is complete and correct.
_________________________________________________________
Student
Date
_________________________________________________________
Parent (required for dependent student)
Date
Return this form along with any other required documentation to:
Financial Aid Office, University of Hawaii at Hilo, 200 W. Kawili Street, Hilo, HI 96720-4091
Or by fax: 808-932-7797
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