12345 El Monte Rd. 21250 Stevens Creek Blvd.
Los Altos Hills, CA 94022-4599 Cupertino, CA 95014-5793
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2017-2018 Independent Verification Worksheet (V1)
Student’s Name: ___________________________________________________________ (Student ID#) SID:___________________
Last First
Preferred Name (if different than above) ___________________________________________________
Last First
Because your FAFSA (Free Application for Federal
Student Aid) was selected for ‘Verification’, we
must verify the tax information reported for you
(and for your spouse, if you’re married). If there
are discrepancies, we will make the necessary
corrections to your FAFSA.
Note: If you filed a 2015 U.S. tax return, try to use the IRS Data Retrieval Tool
(IRS DRT) through your FAFSA. If you are unable to use or choose not to use the
IRS DRT, you must attach an IRS Tax Return Transcript. If you did not file taxes,
you must attach a Verification of Non-filing Letter. To get these and other types
of transcripts, you can go to or call 1-800-
908-9946. Go to your campus’ Financial Aid webpage for more information.
SECTION A. Tax Information
Important Note: The instructions for this form apply to income earned by you (and by your spouse, if you are married). If you are
married, and you and your spouse filed separate 2015 IRS income tax returns or you had a change in marital status after December
31, 2015, please contact the Financial Aid Office for more information.
Do not submit this form until you have successfully completed the IRS DRT and/or have attached all required documents. If you
need clarification or are unable to obtain the necessary documents, please contact your campus’ Financial Aid Office.
Box 2: Complete this box only if you (and/or your spouse, if you are married) did not file a 2015 Income Tax Return
in any country.
You must attach an IRS Verification of Non-filing Letter for 2015 for the person(s) who did not file.
Check and complete all that apply:
I have attached an IRS Verification of Non-filing Letter for 2015 for the person(s) who did not file.
I (and/or my spouse) was/were not employed and had no 2015 income earned from work (including business income, odd jobs, etc.). If this
applies to only you or your spouse because you were not married in 2015, please indicate which one: Yourself Your Spouse
I (and/or my spouse) was/were employed in 2015 and have listed below the names of all employers, the amount earned
from each employer in 2015, and whether the employer provided a W-2 form.
List every source of income earned in or out of the U.S., even if a W-2 form was not issued; include odd jobs, etc.
You must attach a copy of all W-2 forms issued. If a W-2 form was not issued, please attach an explanation.
Employer’s (source’s) Name
If married, indicate “Self”
or “Spouse”
Amount earned in 2015
IRS W-2 Form
If earned outside of the
U.S., which country?
Sarah’s Bakery
If you need more space, please attach a signed separate page with the students name and ID number at the top.
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_________________________________________________________________________ _______________________________
Student’s Last Name First Name SID
SECTION B. Family Information
Please list the following people in the chart below:
Your spouse, if you are married.
Your children only if you will provide more than half of the children’s financial support from
July 1, 2017 through June 30, 2018.
Other people currently living with you only if you currently provide and will continue to provide
more than half of their financial support from July 1, 2017 through June 30, 2018.
Do not include any people who live with you but support themselves with their own income,
even if they share some expenses.
Full Name
Relationship to Applicant
Name of College (if attending half-time or
more during the 2017-18 academic year)
Susan Jones
(name of your primary college)
*NOTE: If you need more space, please attach an additional page with the student’s name and ID number at the top.
Section C. Sign This Worksheet
By signing this worksheet, I certify that all the information reported to qualify for federal student aid is complete
and correct. I understand that, periodically, additional documents and/or information may be requested of me and my
family by the Financial Aid Office.
_______________________________________ _____________________
Student’s Signature Date