Dependent Verification Worksheet
2015-2016
STUDENT INFORMATION
Student Name___________________________________________
Last
First
MI
Banner ID + ______________________________________
INSTRUCTIONS
Your FAFSA has been selected for Federal verification which requires our office to verify certain data from your FAFSA For more
information and instructions, please visit the ‘Your Money’ tab of www.MiamiOh.edu/OneStop and click on the Federal
Verification link. The IRS data retrieval tool or an IRS tax return transcript is the only acceptable documentation.
This process must be complete before we can apply your aid to your account; therefore we encourage you to submit all
requirements within 30 days of receipt of request. For your convenience, you can scan & e-mail or fax information to us using
the contact information below.
HOUSEHOLD INFORMATION
Dependent Student’s Family Information
List below the people in your parent(s)’ household. Include:
 Yourself and your parent(s) (including a stepparent) even if you don’t live with your parent(s).
 Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2015 through June
30, 2016, or if the other children would be required to provide parental information if they were completing a FAFSA for
2015-2016. Include children who meet either of these standards, even if they do not live with your parent(s).
 Other people if they live with your parent(s) and your parent(s) provide more than half of their support and will continue to
provide more than half of their support through June 30, 2016.
Include the name of the college for any household member, excluding your parent(s), who will be enrolled at least half time in a
degree, diploma, or certificate program at a postsecondary education institution any time between July 1, 2015 and June 30, 2016.
If more space is needed, attach a separate page with the student’s name and Banner ID number at the top.
HOUSEHOLD MEMER’S N!ME
AGE
RELATIONSHIP TO STUDENT
SELF
COLLEGE NAME
WILL BE ENROLLED AT
LEAST HALF TIME?
Miami University
For office use only:
Miami University - One Stop for Student Success Services - 301 S. Campus Ave. - Oxford, OH 45056
513-529-0001 - Email: [email protected] - Fax: 513-529-8713 - Web: MiamiOH.edu/OneStop
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Page 2
Student Name___________________________________________
Banner ID_______________________________________
FEDERAL TAX RETURN FILING STATUS
PARENT
STUDENT
Filing Status (CHECK ONE):
Filing Status (CHECK ONE):
My parent(s) have already filed their 2014 return &:
I have already filed my 2014 return &:
Used the IRS data retrieval tool via the FAFSA
Used the IRS data retrieval tool via the FAFSA
Requested an IRS tax return transcript
Requested an IRS tax return transcript
My parent(s) will but have yet to file their 2014 return.
I will but have yet to file my 2014 return.
My parent(s) were not employed and had no income
earned from work in 2014.
I was not employed and had no income in 2014.
My parents will not and are not required to file.
If your parents did not file, list all sources of income
received in 2014. If they had no income, list “$0” on
each line.
SOURCE OF INCOME
ANNUAL AMOUNT
Income earned from Work
$___________
Child Support Received
$___________
Worker’s ompensation
$___________
Untaxed Pensions
$___________
Additional Income (List source)
$___________
I will not and am not required to file.
If you did not file, list all sources of income received in
2014. If you had no income, list “$0” on each line.
SOURCE OF INCOME
ANNUAL AMOUNT
Income earned from Work
$___________
Worker’s ompensation
$___________
Untaxed Pensions
$___________
Additional Income (List source)
$___________
If you did not file taxes and the above items are completed
with zero income, we are required to have a statement
from you explaining how you are financially supporting
yourself and living with no income. Please attach a written
statement signed by you with this information, so that your
verification can be completed. If you have any questions,
please contact your financial aid counselor.
SIGNATURES (REQUIRED)
CERTIFICATION: I certify that all information reported to qualify for federal student aid is complete and correct.
______________________________
Student Signature (required)
___________
Date
_____________________________
Parent Signature (required)
____________
Date
For office use only:
Miami University - One Stop for Student Success Services - 301 S. Campus Ave. - Oxford, OH 45056
513-529-0001 - Email: [email protected] - Fax: 513-529-8713 - Web: MiamiOH.edu/OneStop
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