Fillable 1920 Verification Worksheet Dependent (Hope College)

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1920 Verification Worksheet Dependent (Hope College)

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Verification Worksheet – Dependent Student
2019-2020
Office of Financial Aid ▪ 100 East 8
th
Street ▪ PO Box 9000 ▪ Holland, MI 49422-9000
P: 616-395-7765 ▪ F: 616-395-7160 ▪ finaid@hope.edu ▪ hope.edu/financialaid
The information on this form is required to process your financial aid application. Complete and return this
form to the Hope College Office of Financial Aid. Use zero to indicate you do not have any dollar
amount to report.
Student Name:
Hope College ID Number:
Household Information
List the people in your parent(s)’ household, including:
yourself and
your parents (including step-parent), and
your parents' other children if your parent/s will provide more than half of their support from July 1, 2019
through June 30, 2020 or if your parent/s would be required to provide parental information on their 2019-20 FAFSA,
and
other household members only if they now live with and receive more than half of their support from your parent/s
and they will continue to receive this support through June 30, 2020.
Full names of ALL
family members
(including parents)
receiving at least 50%
of support from your
parents:
Age:
Relationship
to student:
Will he/she be
enrolled in a
degree
program at a
college/univer
sity at least
half-time in
2019-2020?
If enrolled in
college/university, what type
of program?
Name of college/university:
Under-
graduate
Graduate
Medical/
Law/
Dental
YOU
SELF □ Yes □ No
□ □ □
HOPE COLLEGE
□ Yes □ No
□ □ □
□ Yes □ No
□ □ □
□ Yes □ No
□ □ □
□ Yes □ No
□ □ □
□ Yes □ No
□ □ □
2017 Income Tax Information
List below your employer(s) and any income received in 2017 even if you do not receive a W-2. Enter N/A if you did not
work or earn income. Do not leave blank. Provide copies of all W-2 statements.
Student:
Source of Income Amount W-2 provided
$
□ Yes □ No
$
$
Parent(s):
Source of Income Amount W-2 provided
$
□ Yes □ No
$
□ Yes □ No
$
□ Yes □ No
Student
Please select one:
□ I have filed a 2017 Federal income tax return and will
provide a Tax Return Transcript or use the IRS Data
Retrieval Tool from the FAFSA at www.fafsa.gov
.
□ I will not file and am not required to file a 2017 Federal
income tax return.
Parent(s)
Please select one:
□ I/We have filed a 2017 Federal income tax return and
will provide a Tax Return Transcript or use the IRS
Data Retrieval Tool from the FAFSA at www.fafsa.gov
.
□ I/We will not file and are not required to file a 2017
Federal income tax return. I will submit confirmation
of non-filing from the IRS using IRS form 4506-T.
Select box 7 on IRS form 4506-T. Documentation must
be dated on or after October 1, 2018. IRS request form
available at www.irs.gov
.
A 2017 IRS Tax Return Transcript may be obtained through:
Get Transcript by MAIL – Go to www.irs.gov
, click “Get Your Tax Record”, then click “Get Transcript by Mail.”
Make sure to request the “IRS Tax Return Transcript” and NOT the “IRS Tax Account Transcript.”
Get Transcript ONLINE – Go to www.irs.gov, click “Get Your Tax Record”, then click “Get Transcript Online.” Make
sure to request the “IRS Tax Return Transcript” and NOT the “IRS Tax Account Transcript.”
Automated Telephone Request – 1-800-908-9946
Paper Request Form – IRS Form 4506T-EZ or IRS Form 4506-T
2017 Untaxed Income Information
Please indicate $0 in any field that does not apply. Do not leave blank.
Student Parent(s)
$
$
Untaxed Social Security benefits received for all household members (including the
untaxed portion of Social Security benefits reported on parents’ IRS Form 1040-line 20a or
1040A-line 14a).
$
$
Untaxed SSI disability benefits received for ALL household members.
$
$
Welfare benefits (including TANF) Do not include food stamps or subsidized housing.
$
$
Child support received for all children. Do not include foster care or adoption payments.
$
$
Foreign income exclusion (IRS Form 2555-line 45; or Form 2555EZ-line 18).
$
$
Housing, food and other living allowances paid to members of the military, clergy, and
others (including cash payments and cash value of benefits). Do not include the value of
on-base military housing or a military BAH.
$
$
Veterans’ non-education benefits such as Disability, Death Pension, Dependency &
Indemnity Compensation (DIC), &/or VA Educational Work Study allowances.
$
$
Worker’s compensation.
$
$
Any other untaxed income or benefits. Describe sources(s):
$
XXXXXXXXX
Cash received or any money paid on your behalf and not reported elsewhere on this form
(include support from family members not listed in your household, as well as distributions
from 529 plans not owned by you or your custodial parents).
Warning: If you purposely give false or misleading information, you may be fined, sent to prison, or
both. Each person signing below certifies that all of the information reported is complete and correct. The student and
one parent whose information was reported on the FAFSA must sign and date.
Parent Signature:
Date Signed:
Student Signature:
Date Signed:
VERWD
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1920 Verification Worksheet Dependent (Hope College)

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Completed 25 July 2020

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