2014-2015 Verification Worksheet – INDEPENDENT Federal Student Aid Programs Your application was selected for review in a process called “Verification”. In this process, UL Lafayette will compare information from your FASFA with this worksheet and financial data you must submit. The law requires completion of Verification before awarding and/or disbursing federal aid. If there are differences between your FAFSA application and your verification documentation, electronic corrections to your FAFSA may be required. Contact UL Lafayette Financial Aid at 337-482-6506, option “0” if you have questions. INSTRUCTIONS 1. Complete all sections of this worksheet in full. 2. Submit your and your spouse’s 2013 Federal Income Tax Return Transcript from the IRS OR log on to www.fafsa.gov and use the IRS Data Retrieval Tool to transfer your 2013 tax information to your 2014-2015 FAFSA. 3. Please return all documents requested to our office via fax to 337-482-6502, email to [email protected] or mail to UL Lafayette, Financial Aid Office, P.O. Box 41206, Lafayette, LA 70504-1206 A. Student Information Last Name M.I. Student ID Number — CLID First Name Your address (include Apt. No.) City Code Date of Birth State Phone number (include area code) ZIP B. Family Information Full Name Age Write the name(s) of the people in your household in the chart below: 1. Include yourself 2. Include your spouse, if you are married. 3. Include your children or your spouse’s children if you or your spouse will provide more than half of their support between July 1, 2014 and June 30, 2015, even if the children do not live with you. 4. Include other dependents, if they now live with you and you or your spouse will provide more than half of their support through June 30, 2015. Write the age of each family member in the chart below. *If someone is age 23 please provide date of birth Relationship Write the relationship of each family member to the student in the chart below. College Add the name of the college for any household member who will be enrolled in a degree, diploma, or certificate program at an eligible postsecondary educational institution at least half-time any time between July 1, 2014 and June 30, 2015 Full Name (EXAMPLE) Missy Jones Age 18 Relationship Self College UL Lafayette *If more space is required, attach a separate page. ANSWER ALL QUESTIONS. INCOMPLETE FORMS WILL BE RETURNED C. Independent Student’s Information (all applicants) 1. Check the box that applies: a. I filed/will file a 2013 Federal IRS Tax Return, Puerto Rican, or Foreign Income Tax Return. b. I was not employed, did not have income and am not required to file a 2013 Federal IRS Tax Return. c. I was employed and had income, but am not required to file a 2013 Federal IRS Tax Return and I will list all my employer(s) (include UL Lafayette) and the amount that was earned in 2013 in the chart below: If you were unable to or chose not to use the IRS Data Retrieval Tool in FAFSA on the web; you must contact the IRS to obtain a copy of your 2013 tax return transcript at: www.irs.gov or 1-800-908-9946. Complete ONLY if Box c. is checked: Name of Employer Amount Earned in 2013 2013 W-2 Form Received From Employer $ W-2 must be submitted $ W-2 must be submitted *If more space is required, attach a separate page. D. Spouse’s Information 1. Check the box that applies: a. Spouse filed/will file a 2013 Federal IRS Tax Return, Puerto Rican, or Foreign Income Tax Return. b. Spouse was not employed, did not have income and is not required to file a 2013 Federal IRS Tax Return. c. Spouse employed and had income, but is not required to file a 2013 Federal IRS Tax Return and will list all spouse’s employer(s) (include UL Lafayette) and the amount that was earned in 2013 in the chart below: If you were unable to or chose not to use the IRS Data Retrieval Tool in FAFSA on the web; you must contact the IRS to obtain a copy of your 2013 tax return transcript at: www.irs.gov or 1-800-908-9946. Name of Employer Amount Earned in 2013 2013 W-2 Form Received From Employer $ W-2 must be submitted $ W-2 must be submitted *If more space is required, attach a separate page. E. Student and/or Spouse Additional Information 1. Did anyone in the student’s household (listed in Section B) receive benefits from SNAP (formerly known as food stamps) at any time during the 2012 or 2013 calendar year? You may be required to submit documentation of receipt of SNAP benefits to the school. _______ Yes _______ No 2. Was child support received for anyone under age 18 in the student’s household (listed in Section B)? _______ Yes _______ No Child Name: ________________________ Total received in 2013: _______________ 3. Did you or anyone in your household pay child support in 2013? (Please check one) _______ Yes* *If Yes, complete the chart below. Legal Name of Person Who Paid Child Support _______ No (Do not include support paid for children included in Section B of this form.) Legal Name of Parent/Guardian to Whom Support Was Paid Legal Name of Child For Whom Support was Paid Annual 2013 Amount Paid Per Child *If more space is required, attach a separate page F. Additional Untaxed Income Calendar Year 2013 INSTRUCTIONS: Student’s Please complete the entire section. Indicate the yearly amount received in 2013 for each of the following questions. ANSWER -0- IF NONE. 2013 Additional Financial Information Taxable earnings from Federal Work-Study and need-based work employment portions of fellowships and assistantships or cooperative education program Student grant and scholarship aid reported to the IRS in your/your parents’ AGI. Includes AmeriCorps benefits (awards, living allowances, and interest accrual payments), as well as grant or scholarship portions of fellowships and assistantships $ $ $ Combat pay or special combat pay. (only enter the amount that was taxable and included in the adjusted gross income. Do not enter untaxed combat pay.) $ $ $ $ $ $ $ 2013 Untaxed Income Student’s $ Spouse’s Spouse’s Payments to tax-deferred pension and retirement savings plans (paid directly or withheld from earnings), including, but not limited to amounts reported on the W-2 Form in Box 12a through 12d codes D,E,F,G,H, and S. Don’t include amounts reported in code DD (employer contributions toward employee health benefits). Housing, food, and other living allowances paid to members of the military, clergy, and others (including cash payments and cash value of benefits). Exclude on-base military housing or the value of a basic military housing allowance. Veterans non-education benefits such as Disability, Death Pension, or Dependency & Indemnity Compensation(DIC) and/or VA Educational Work-Study allowances Other untaxed income such as: worker's compensation, disability, etc. Also include the untaxed portions of health saving accounts from IRS Form 1040 – line 25. [Don't include student aid, earned income credit, additional child tax credit, welfare payments, untaxed Social Security benefits, Supplemental Security Income, Workforce Investment Act educational benefits, combat pay, benefits from flexible spending arrangements (e.g. Cafeteria plans), foreign income exclusion or credit for federal tax on special fuels.] Money received, or any money paid on your behalf, not reported elsewhere on this form (e.g., bills) $ $ $ $ F. Certification and Signatures By signing this worksheet, we certify that all the information reported to qualify for federal student aid is complete and correct. __________________________________________________________________________ Student Date __________________________________________________________________________ Spouse Date Warning: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.