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Independent
2014-2015 Verification Worksheet
Federal Student Aid Programs
Your application was selected for review in a process called “Verification.” In this process, your school will be
comparing information from your FAFSA application with copies of your and your spouse's 2013 Federal tax return
transcripts, or other financial documents. The law says we have the right to ask you for this information before
awarding Federal aid. If there are differences between your FAFSA application information and your financial
documents, you or your school may need to make corrections electronically or by using your Student Aid Report (SAR).
1. Submit the completed 2014-2015 Independent Verification Form. Make sure the form is signed by the student.
This form is three -sided and needs to be filled out completely; if the answer is zero write “0”, do not leave blank.
2. If the number in household and/or college you are reporting now on the Verification Worksheet does not match the
number(s) you reported on the FAFSA, submit a written explanation of the discrepancy which must be signed by
the student.
3. Submit 2013 Federal Tax Transcript(s) for both student and spouse, if filed. As per federal regulations, we
can no longer accept copies of the filed federal tax return unless it is specifically requested by the financial aid
department. You can obtain a Federal Tax Return Transcript by calling the IRS at 1-800-908-9946.
4. IF FILED: The following schedules and forms are required from your tax return.
Schedule C (business income)
Schedule E (property rental, royalties, S corps, trusts, etc.)
1099 R (distributions from IRS, pensions and annuities etc.)
5. If Food Stamps were received by any household member reported on this form for 2012 or 2013 submit
supporting documentation to verify this, such as a copy of the Food Stamp Benefit Card.
6. If child support was paid, submit a print-out of child support paid. Also indicate to whom it was paid and for
which children.
A. Student information
YSU ID Number
Address (include apt. #)
Date of birth
City
State
Zip Code
\
Phone number (include area code) / Cell phone #
Last name
First name
M.I
B. Family Information
List the people in your household, including:
• yourself and your spouse if you have one, and
• your children, if you will provide more than half of their support from July 1, 2014 through June 30, 2015, 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 from July 1, 2014 through June 30, 2015
Write the names of all household members in the space(s) below. Also write in the name of the college for any household member, excluding your
parent(s), who will be attending at least half time between July 1, 2014 and June 30, 2015, 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
YSU
C. Student’s Tax Forms and Income Information (all applicants)
1.
Check only one box below. Tax transcripts include the 2013 IRS transcript from filing Form 1040, 1040A, 1040EZ, and a tax return from
Puerto Rico. Tax transcripts can be obtained by calling the IRS at 1-800-908-9946.
 Check here if you are attaching a copy of your tax transcript.
 Check here if a tax transcript will be submitted to the school by (date).
 Check here if you will not file and are not required to file a 2013 U.S. Income Tax Return. (Submit copy of W-2 for each source of
employment income.)
2.
Funds received for child support and other untaxed income
Source of Untaxed Income
3.
2013 Amount
Source of Untaxed Income
2013 Amount
a. Child Support
$
d.
$
b. Workman's Compensation
$
e.
$
c. Untaxed Pensions
$
f.
$
If you did not file and are not required to file a 2013 Federal income tax return, list below your employer(s) and any income received in 2013
(You must provide the W-2 form or other earnings statements with this form).
Sources
2013 Income
$
$
$
D. Spouse's Tax Forms and Income Information (if student is married)
1.
2.
Check only one box below. Tax transcripts include the 2013 IRS transcript from filing Form 1040, 1040A, 1040EZ, or a tax return from Puerto
Rico. Tax transcripts can be obtained by calling the IRS at 1-800-908-9946.
 Check here if you are attaching a copy of your spouse's joint tax transcript.
 Check here and attach spouse's tax transcript if your spouse filed a seperate tax return.
 Check here if spouse's tax transcript will be submitted to the school by (date).
 Check here if your spouse will not file and are not required to file a 2013 U.S. Income Tax Return. (Submit copy of W-2 for each source
of employment income.)
Funds received for child support and other untaxed income
Source of Untaxed Income
3.
2013 Amount
Source of Untaxed Income
2013 Amount
a. Child Support
$
d.
$
b. Workman's Compensation
$
e.
$
c. Untaxed Pensions
$
f.
$
If you did not file and are not required to file a 2013 Federal income tax return, list below your employer(s) and any income received in 2013
(You must provide the W-2 form or other earnings statements with this form).
Sources
2013 Income
$
$
$
$
Student/Spouse
Parents’
(Q94)
$$
$
$$
$
$
b. Child support paid because of divorce or separation or as a result of a legal
requirement.
Don’t include support for children in your (or your parents’) household, as reported in question
96 (or question 75 for your parents).
2008
2013 Additional Financial Information
2012
c. Taxable earnings from need-based employment programs, such as Federal
a.a.Education
or Lifetime
Learning
taxIRS Form
Educationcredits
credits(American
(Hope andOpportunity
Lifetime Learning
tax credits)
from
Work-Study and need-based employment portions of fellowships and
49
1040—line
50
orForm
1040A—line
31. 49 or 1040A—line 31.
credits)
from
IRS
1040—line
assistantships.
b. Child support paid because of divorce or separation or as a result of a legal
d.requirement.
Grant and scholarship aid reported to the IRS in the adjusted gross income.
Includes
AmeriCorps
benefits
(awards,
allowances
interest accrual
payments),
as well
Don’t
include
support for
children
in yourliving
(or your
parents’)and
household,
as reported
in question
grant
and scholarship
73 for yourportions
95as(or
94
question
75
parents).of fellowships and assistantships.
Combatearnings
pay or special
combat pay.
c.e.Taxable
from need-based
employment programs, such as Federal
Only enter the and
amount
that was taxable
and included
in the adjusted
gross income.
Do not enter
Work-Study
need-based
employment
portions
of fellowships
and
untaxed combat pay reported on the W-2 (Box 12, Code Q).
assistantships.
d. Grant and scholarship aid reported to the IRS in the adjusted gross income.
Includes AmeriCorps benefits (awards, living allowances and interest accrual payments), as well
as grant and scholarship portions of fellowships and assistantships.
the tables
below
e. Combat pay orUse
special
combat
pay. to report annual amounts.
$
Student’s
(Q46)
Parent(s)
$$
$$
$$
$
$
For the Parents’ column, enter the
amount
foramount
the student’s
For
the Student’s
column,
enter
the amount
the student (and his or her spouse).
Only
enter the
that wasparent(s).
taxable and
included
in the adjusted
gross
income.
Do notfor
enter
Parents’ (Q94)
Parents’
(Q95)
$
Student/Spouse
$
$
$$
$
$
$$
$
$
Parents’ (Q95)
$
$
$$
$
$$
$
$
$
$
$
$
untaxed combat pay. reported on the W-2 (Box 12, Code Q).
2008 Additional Financial Information
a cooperative
education
program offered by a
f. Earnings from work under
2008
Untaxed
Income
college.
2013
2008
Untaxed
Income
2012
b. Child support paid because
of divorce
or separation
or as a result of a legal
requirement.
a. Payments to tax-deferred pension and savings plans (paid directly or withheld
Don’tearnings),
include
for children
yourlimited
(or your
parents’)
household,
as reported
question
a.from
Payments
tosupport
tax-deferred
pension
and
savings
plans
(paid
directly
orinwithheld
including,
butinnot
to,
amounts
reported
on the
W-2
96 (or question 75 for your parents).
from in
earnings),
including,
limited
to,F,amounts
reported
on the W-2
forms
Boxes 12a
through but
12d,not
codes
D, E,
G, H and
S.
Taxable
from
need-based
employment
programs,
suchKeogh
as Federal
forms
inearnings
Boxesand
12a
through
12d,
codes
D, E, F,SEP,
G, HSIMPLE,
and S.
b.c.IRA
deductions
payments
to self-employed
and
Work-Study and need-based employment portions of fellowships and
other
qualified plans from IRS Form 1040—line 28 + line 32 or 1040A—line 17.
assistantships.
IRA support
deductions
and payments
to self-employed SEP, SIMPLE, Keogh and
c.b.Child
received
for all children.
d.Don’t
Grant
and foster
scholarship
aid reported
to 1040—line
the IRS in the
income.
other
qualified
plans
from
IRS
Form
28 adjusted
+ line 32gross
or 1040A—line
include
care
or adoption
payments.
Includes
AmeriCorps benefits (awards, living allowances and interest accrual payments), as well
17.
as grant and scholarship portions of fellowships and assistantships.
d. Tax exempt interest income from IRS Form 1040—line 8b or 1040A—line 8b.
2008 pay.
Untaxed Income
e. Child
Combat
pay orreceived
special combat
c.
support
for
all children.
e. Untaxed
portions
of
IRA
distributions
from in
IRS
1040—lines
Only enter the amount that was taxable and included
the Form
adjusted
gross income. (15a
Do not enter
untaxed
combat
pay
reported
on the(11a
W-2
(Box 12,11b).
Code Q).
minus
15b)
or
1040A—lines
minus
Don’t
include
foster
care
or adoption
payments.
Exclude rollovers. If negative, enter a zero here.
Tax exempt
interest
income from
or 1040A—line
f.d.Untaxed
portions
of pensions
from IRS
IRS Form
Form 1040—line
1040—lines8b(16a
minus 16b) or
8b.
a.1040A—lines
Payments to tax-deferred
pensionExclude
and savings
(paidenter
directly
withheld
(12a minus 12b).
rollovers.plans
If negative,
a zeroor
here.
from earnings), including, but not limited to, amounts reported on the W-2
g. Housing,
food and other living allowances paid to members of the military,
e.clergy
Untaxed
of through
IRA distributions
IRS
Form
1040—lines
(15a
forms in portions
Boxes 12a
12d, codesfrom
D, E,
F, G,
H and
S.
and others (including cash payments and cash value of benefits).
minus 15b) or 1040A—lines (11a minus 11b).
the value
of payments
on-base military
housing or the value
of aSIMPLE,
basic military
allowance
b.Don’t
IRAinclude
deductions
and
to self-employed
SEP,
Keogh
and
for housing.
Exclude
rollovers. Ifplans
negative,
enter
a zero
here.
other qualified
from
IRS
Form
1040—line 28 + line 32 or 1040A—line
h. Veterans
noneducation benefits such as Disability, Death Pension, or
17.
& Indemnity
Compensation
(DIC)1040—lines
and/or VA Educational
f.Dependency
Untaxed portions
of pensions
from IRS Form
(16a minus 16b) or
c.Work-Study
Child support
received for all children.
allowances.
1040A—lines (12a minus 12b). Exclude rollovers. If negative, enter a zero here.
Don’t include foster care or adoption payments.
i. Other untaxed income not reported, such as workers’ compensation,
g.
Housing,
food
and other
living
allowances
to members
of1040A—line
the military,
etc.
d.disability,
Tax exempt
interest
income
from
IRS Formpaid
1040—line
8b or
clergy and others (including cash payments and cash value of benefits).
8b.
Don’t include student aid, earned income credit, additional child tax credit, welfare payments,
untaxed Social Security benefits, Supplemental Security Income, Workforce Investment Act
e.educational
portions
of IRA
distributions
from IRS
Form
1040—lines
(15a
combat
pay,
benefitssuch
from as
flexible
spending
arrangements
(e.g.,or
cafeteria
h. Untaxed
Veteransbenefits,
noneducation
benefits
Disability,
Death
Pension,
minus
15b)income
or 1040A—lines
(11aforminus
plans),
foreign
exclusion or credit
federal 11b).
tax on special fuels.
$
PAGE
WORKSHEET
Dependency
& Indemnity Compensation (DIC) and/or VA Educational
$ 8 2009-2010 FAFSA ON THE WEB
$
Exclude rollovers. If negative, enter a zero here.
$
$
Sign Worksheet
$
$
XXXXXXXXXX
Work-Study
allowances.
j. Money
received,
or paid on your behalf (e.g., bills), not reported elsewhere on
f.this
Untaxed
portions
of pensions from IRS Form 1040—lines (16a minus 16b) or
form.
i. Other
untaxed (12a
income
not 12b).
reported,
suchrollovers.
as workers’
compensation,
1040A—lines
minus
Exclude
If negative,
enter a zero here.
disability, etc.
g. Money
Housing,
food and
other
living
allowances
paid
to members
of the
military,on
j.
received,
paid
on
your
(e.g.,
bills),
reported
elsewhere
Don’t include
studentoraid,
earned
incomebehalf
credit, additional
childnot
tax credit,
welfare
payments,
clergy
and others
(including
cash payments
cashWorkforce
value of Investment
benefits).Act
untaxed
Social
Security
benefits, Supplemental
Securityand
Income,
this
form.
Student’s (Q46)
Student’s
(Q47)
$
Parent(s)
Student’s
(Q47)
$
$
$$
$
$
$$
$
$
Student’s (Q47)
$
$
$$
$
$$
$
$
$
$
$
$
$
$ WWW.FAFSA.ED.GOV
$
$
XXXXXXX
$$
$
educational
benefits,
combat
benefits from flexible
spending arrangements (e.g., cafeteria
Each person signing this form
certifies
that
all pay,
information
reported
h. Veterans
noneducation
benefits
such
as Disability,
Death
Pension, or If you purposely give false or
WARNING:
plans),
foreign
income exclusion
or credit
for date.
federal
tax on special
fuels.
on it is complete and correct.
The
student
must sign
and
Student
Date
Spouse
Date
misleading information on this worksheet,
you may be fined, be sentenced to jail,
or both.
Notes: