Verification Worksheet, Independent Student

Verification Worksheet, Independent Student
2014 – 2015 Academic Year
V1/V5/V6
Your 2014–2015 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, the financial aid officer at Durham Tech will
compare your FAFSA with the information on this worksheet and with 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 as soon as
possible so that your financial aid will not be delayed.
Independent Student’s Information
_____________________________________________________________
____________________________________
Student’s Last Name
Student ID or Social Security Number
First Name
M.I.
_____________________________________________________________
____________________________________
Street Address (include apt. no.)
Date of Birth
_____________________________________________________________
____________________________________
City
Student’s Email Address
State
Zip Code
_____________________________________________________________
____________________________________
Home Phone Number (include area code)
Cell Phone or Alternate Number
Independent Student’s Family Information
List the people in your household below. Include:
 Yourself;
 Your spouse, if you are married;
 Your children, if you will provide more than half of their support from July 1, 2014, through June 30, 2015,
or if the child would be required to provide your information if they were completing a FAFSA for 2014–
2015. Include children who meet either of these standards, even if they do not live with you; 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, through June 30, 2015.
Please include each household member, including those who will be enrolled at least half-time, in a degree,
diploma, or certificate program at a post-secondary educational institution any time between July 1, 2014 and
June 30, 2015.
(Example)
Full Name
Age
Relationship
In College?
Mary Smith
28
SPOUSE
Name of College
SELF
Durham Tech
Will be Enrolled at
Least Half Time?
DAUGHTER
SON
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Independent Verification Worksheet
C. Independent Student’s Income Information to Be Verified
Important Note to Tax Return Filers: If you (or your spouse) filed, or will file, an amended 2013 IRS tax
return, you must contact a financial aid officer before completing this section.
Instructions: Complete this section whether you, the student (or your spouse), filed, will file, or will not file a
2013 income tax return with the IRS. The best way for the college to verify your income is for you to use the
IRS Data Retrieval Tool, which is part of the FAFSA application.
If you have not already used the tool, log in to your FAFSA record at FAFSA.gov, select “Make FAFSA
Corrections,” and navigate to the Financial Information section of the form. From there, follow the instructions to
determine if you are eligible to use the IRS Data Retrieval Tool to transfer 2013 IRS income tax information into
your FAFSA.
Check the box that applies:
I, the student, (and, if married, my spouse) was not employed and had no income earned from work in
2013. (Please complete the ‘Verification of Income/Non-Filer Form’).
I, the student, (and, if married, my spouse) was employed and had income earned from work in 2013 but
was not required to file. (Please complete the ‘Verification of Income/Non-Filer Form’ and include all 2013
W-2 Forms)
I, the student, have used the IRS Data Retrieval Tool in FAFSA on the Web to transfer my (and my
spouse’s) 2013 IRS income information into my FAFSA, either on the initial FAFSA or when making a
correction to the FAFSA. Durham Tech will use the transferred IRS information in the verification process.
I, the student, am unable to or choose not to use the IRS Data Retrieval Tool in FAFSA on the Web, and
I will submit to the school 2013 IRS tax return transcript(s)—not photocopies of the Federal 1040 tax
return. To obtain an IRS tax return transcript, go to http://www.irs.gov/Individuals/get-transcript or call 1800-908-9946. Make sure to request the “IRS tax return transcript” and not the “IRS tax account
transcript.”
Check here if an IRS tax return transcript(s) is attached to this worksheet.
D. SNAP Benefits
Please check the appropriate box below:
One of the persons listed in Section B of this worksheet received SNAP benefits (formerly food stamps) in
2012 or 2013. If requested by Durham Tech, I will provide documentation of the receipt of SNAP benefits
during 2012 and/or 2013.
No person(s) listed in Section B of this worksheet received SNAP benefits in 2012 or 2013.
E. Certification and Signature
I certify that all of 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 on this worksheet,
you may be fined, sentenced to jail, or both.
_________________________________________________
__________________________________
Student’s Signature (Required)
Date
_________________________________________________
__________________________________
Spouse’s Signature (Optional)
Date
Please return this completed form to:
Durham Technical Community College, Financial Aid office
1210 Wynn Student Services Center – Main Campus
1637 Lawson Street, Durham, NC 27703
Fax: 919-686-3672 Email: [email protected]
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