This form is required for the student if they did not and were not required to file a 2017 federal income tax
return.
Student’s information:
________________________________ _____________________ _____________________
Student Last Name Student First Name Goucher ID Number
Please indicate the sources and amounts of any income during the 2017 year. Any foreign income should be
converted to U.S. dollars. (http://finance.google.com/finance/converter)
(Please indicate “N/A” and an amount of $0 if you had no income.)
If you had income, you will need to provide copies of 2017 W2’s and/or 1099 forms from ALL employers. Replacement
copies may be obtained from your employer or by requesting a 2017 Wage and Income Transcript from the IRS. If a W2
or 1099 was not issued to you for some reason, then please explain:
_________________________________________________________________________________
Signed Statement of Non-Filing
STATEMENT OF UNDERSTANDING
I certify that all of the information provided and any supporting documentation submitted is true and accurate.
I certify that I was not required to file a 2017 tax return with the IRS.
I certify that I attempted to obtain a verification of nonfiling from the IRS or other tax authority and was unable to obtain
the required documentation.
I understand that if information provided establishes that it appears I was required to file (as per IRS regulations in
Publication 17), that additional documentation may be necessary to establish why I was not required to file.
I understand that if I was required to file a 2017 return and am unable or unwilling to file, then I will not be eligible for any
federal financial aid programs, including federal student loans, and may not be eligible for other types of need-based
financial aid.
I understand that any outstanding balance to Goucher College based on any change in eligibility for financial aid becomes
my responsibility to pay.
_____________________________________________ _____________________________
Student’s Signature Date
(ELECTRONIC SIGNATURES NOT ACCEPTED. Please print & sign in ink, then mail, fax, or scan and e-mail.)
