________________ Empower Number ___________________________________________________________ Last Name First Name 2014-15 Verification Worksheet Your Free Application for Federal Student Aid (FAFSA) has been selected for a review process called verification. During this process, the Financial Aid office will compare the information you reported on your FAFSA with additional documents that you are required to submit to our office. Federal law mandates that we complete this review prior to awarding you any federal financial aid. It is to your advantage to complete this process as soon as possible so that your financial aid won’t be delayed. When filing the FAFSA, students, spouses, and parents should transfer federal tax return information electronically from the Internal Revenue Service (IRS) onto the FAFSA using the IRS Data Retrieval Tool. This tax return information, if unchanged, will be considered “verified” for FAFSA purposes and you will not be required to submit a 2013 Federal Tax Return Transcript from the IRS. If you filed a 2013 Federal Tax Return and are unable to transfer your tax return information onto your FAFSA using the IRS Data Retrieval Tool, you are required to submit a 2013 Federal Tax Return Transcript from the IRS with this Verification Worksheet. You can request a tax return transcript at www.irs.gov/transcript - select “Get Transcript ONLINE.” If you are required to but have not yet filed your 2013 Federal Tax Return, you must do so prior to completing the verification process. Complete this worksheet and return it with all required documentation attached. Include your Empower Number on all pages of each document. Incomplete and/or unsigned documents will be returned for completion and will delay processing time. ALL STUDENTS (If you are married also report for your spouse): Check only one box Check this box if you have filed your 2013 Federal Tax Return(s) Check this box if you did not, will not, and are not required to file a 2013 Federal Tax Return PARENT(S) OF DEPENDENT STUDENTS: Check only one box. Check this box if you have filed your 2013 Federal Tax Return(s) Check this box if you did not, will not, and are not required to file a 2013 Federal Tax Return ALL STUDENTS: If you, your spouse, or your parent(s) filed a 2013 Amended Federal Tax Return, you are required to attach each of the following: A signed copy of the original 2013 Federal Tax Return that was filed with the IRS A signed copy of the IRS Form 1040X that was filed with the IRS A 2013 Federal Tax Return Transcript ALL NON-TAX FILERS: If you were not required to file a 2013 Federal Tax Return but you did work, list below all employers and income earned from each employer in 2013. Use W-2 forms or other earnings statements to complete this section and attach copies of those documents. Student/Spouse/Parent(s) Name Employer/Source of Income Earned from Work 2013 Amount $ $ $ $ ________________ Empower Number ___________________________________________________________ Last Name First Name ALL STUDENTS: Dependent Students (You were required to report parent information on the FAFSA) Independent Students (You were not required to report parent information on the FAFSA) List your family members below, including: List your family members below, including: Yourself (even if you do not live with your parents) Yourself Your parent(s) (list only the parent(s) whose information Your spouse (if married) was provided on the FAFSA Your children and/or stepchildren (do not include Your parents’ other children, if your parents provide children for whom you are paying child support) more than half of their support and the children would Other people, only if they live with you now, they be considered dependent when applying for federal receive more than half of their support from you (and student aid (do not include children for whom your your spouse, if married), and they will continue to parents are paying child support) receive this support between July 1, 2014 and June 30, Other people, only if they live with your parent(s) now, 2015 they receive more than half of their support from your parents, and they will continue to receive this support between July 1, 2014 and June 30. 2015 Full Name of Family Member Age Relationship to Student College* Self Mercy College Enrollment Status** (FT/HT/LHT) *If any family member, excluding parents, will be attending college at least half-time between July 1, 2014 and June 30, 2015, and will be enrolled in a degree, diploma, or certificate program, also include the name of the college they will be attending. ________________ Empower Number ___________________________________________________________ Last Name First Name LIST BELOW OTHER TYPES OF INCOME YOU MAY HAVE RECEIVED IN 2013: Student(and spouse,if married) $ $ $ Source of Untaxed Income Received in 2013 Child Support RECEIVED for all children. Don’t include foster care or adoption payments Housing, food, and other living allowances paid to members of the military, clergy, and others (including cash payments and cash value of benefits). Don’t include the value of on base military housing of the value of a basic military allowance for housing Veterans’ non-education benefits, such as Disability, Death Pension, or Dependency and Indemnity Compensation (DIC), and/or VA Educational Work-Study allowances. Other untaxed income such as workers’ compensation, disability, etc. Also include the untaxed portions of health savings accounts from IRS Form 1040-line 25. $ Parent(s) $ $ $ $ Money received by you to help with bills, living expenses, other educational costs, etc. This includes money that you received from a non-custodial parent that is not part of a legal child support agreement. $ $ $ Payments to tax-deferred pension and retirement savings plans (paid directly or withheld from earnings), including, but not limited to, amounts reported on W-2 forms in Boxes 12a through 12d, codes D, E, F, H, and S. Don’t include amounts reported in code DD (employer contributions toward employee health benefits). $ AS OF THE DATE YOU FILED YOUR 2014-2015 FAFSA, PLEASE INDICATE MARITAL STATUS BELOW: DEPENDENT STUDENTS: My parent(s) marital status is: Report the marital status only for the parent(s) whose information was included on the FAFSA Never married Unmarried and both parents are living together Married or remarried. Provide the month and year your parents were married: Month:________ Year:_________ Divorced or separated. Provide the month and year your parents were divorced or separated: Month:_________ Year:_________ Widowed. Provide the month and year your parent was widowed Month:_________Year:_________ INDEPENDENT STUDENTS: My Marital status is: Never married Married of remarried. Provide the month and year you were married Month:_______Year:_________ Divorced or separated. Provide the month and year you were divorced or separated. Month:_______Year:_________ Widowed. Provide the month and year you were widowed. Month:_______Year:_________ ________________ Empower Number ___________________________________________________________ Last Name First Name ALL STUDENTS AND PARENTS OF DEPENDENT STUDENTS ARE REQUIRED TO PROVIDE SIGNATURES BELOW: Certification Statement: By signing this worksheet, I (we) certify that all of the information reported above, used to determine eligibility for federal student financial aid, is complete and correct. WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both. __________________________________________________________ Student Signature Date __________________________________________________________ Parent Signature Date RETURN TO: Mercy College Financial Aid Office 2221 Madison Ave Toledo, OH 43604 Fax Number: 419-251-0969 Email: [email protected] Questions? Please contact the Financial Aid Office at 419-251-1219