F. CERTIFICATIONS
Electronic Certification Agreement. By providing your full student ID # below and by selecting the "I Accept" button, you consent that all of the
information reported is complete and correct. You further agree that you will submit a Dependent Verification Worksheet Affidavit Signature Form, with
original signatures of BOTH the student and parent, for verification purposes.
WARNING: If you purposely give false or misleading
information on the worksheet, you may be fined, be sentenced to jail, or both.
I Accept
ID # (MUST start with A)
Student's Full Name
To electronically submit this form you MUST use the "SUBMIT" button located at the top of this form.
You MUST have Adobe Reader 9 or higher to submit this form electronically.
If you DO NOT see a submit button in the top right of this form you will need to
To verify your form was properly submitted, allow 48 hours then check your "Financial Aid Status" in your Banner Self Service account.
E. DEPENDENT PARENT'S TAX INFORMATION TO BE VERIFIED
Did the parent (and if married, the parent's spouse) file / will file a 2012 tax return? (See drop down menu for options)
IMPORTANT INFORMATION: If the parent (and, if married, the parent's spouse) filed, or will file, an amended 2012 IRS tax return, you must contact
your financial aid administrator before completing this section.
The best way to verify income is by using the IRS Data Retrieval Tool that is part of FAFSA online. If you have not already used the tool, go to FAFSA.
gov, log in to your FAFSA record, 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 2012 IRS income tax information into your FAFSA. It takes up to
two weeks for IRS income information to be available for the IRS Data Retrieval Tool for electronic IRS tax return filers, and up to eight weeks for paper
IRS tax return filers. If you need more information about when, or how to use the IRS Data Retrieval Tool see your financial aid administrator.
I, the parent (and, if married, the parent's spouse).... (See drop down menu for options)
Complete the section below ONLY if the parent (and, if married, the parent's spouse) were employed in 2012 AND DID NOT file a 2012 tax return.
You MUST provide documentation of all monies earned (e.g. copy of W-2).
Employer's Name Total Amount Earned in 2012 Received a W-2
Student Certification:
You MUST submit a Dependent Verification Worksheet Affidavit Signature Form, with original signatures of BOTH the
student and parent, before your financial aid can be finalized. (http://www.sunyorange.edu/financialaid/forms/docs/1213AFFIDAVITDVF_000.pdf)
Parent Certification:
I Accept
Parent's Full Name
Office Use Only
Submitted Notified N/A Submitted Notified N/A
Initials: SNAP SW2
CSP MW2
STT PW2
PTT DAVD
