Fillable 2013 14 Dep V5 Worksheet (Golden Gate University)

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2013 14 Dep V5 Worksheet (Golden Gate University)

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2013–2014 Verification Worksheet
Dependent Student- Tracking Group V5
Your 2013–2014 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that
before awarding Federal Student Aid, we may ask you to confirm the information you and your parents reported on your FAFSA. To verify that
you provided correct information the financial aid administrator at your school will compare your FAFSA with the information on this worksheet
and with any other required documents. If there are differences, your FAFSA information may need to be corrected. You and at least one
parent must complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the
financial aid administrator at your school. Your school may ask for additional information. If you have questions about verification, contact your
financial aid administrator as soon as possible so that your financial aid will not be delayed.
A. Depe
ndent Student’s Information
Student’s Last Name Student’s First Name Student’s M.I.
Student’s SSN or ID Number
Student’s Street Address (include apt. no.)
Student’s Date of Birth
City State Zip Code
Student’s Email Address
Student’s Home Phone Number (include area code)
Student’s Alternate or Cell Phone Number
B. Dependent Student’s Family Information
List below the people in your
parent(s)’ household. Include:
• Yourself and your parent(s) (including a stepparent) even if you don’t live with your parent(s).
• Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2013, through June 30, 2014,
or if the other children would be required to provide parental information if they were completing a FAFSA for 2013–2014. Include
children who meet either of these standards, even if they do not live with your parent(s).
• Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will continue to
provide more than half of their support through June 30, 2014.
Include the name of the college for any household member, excluding your parent(s), who will be enrolled,
at least half time in a degree,
diploma, or certificate program at a postsecondary educational institution any time between July 1, 2013, and June 30, 2014. If more space
is needed, attach a separate page with the student’s name and Social Security Number at the top.
Full Name
Age
Relationship
College
Will be Enrolled at
Least Half Time
Missy Jones (example) 18 Sister Central University
Yes
1
Student Name:
Student ID Number:
C. Dependent Student’s Income Information to Be Verified
1. TAX RETURN FILERS
Important Note: If the student filed, or will file, an
amended 2012 IRS tax return, the student must contact the financial aid administrator
before completing this section.
Instructions: Complete this section if the student,
filed or will file a 2012 income tax return with the IRS. The best way to verify income is by
using the IRS Data Retrieval Tool that is part of FAFSA on the Web. If the student has not already used the tool, go to FAFSA.gov, log in to
the student’s FAFSA record, select “Make FAFSA Corrections,” and navigate to the Financial Information section of the form. From there,
follow the instructions to determine if the student is eligible to use the IRS Data Retrieval Tool to transfer 2012 IRS income tax information
into the student’s 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.
Check the box that applies:
The student
has used the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer 2012 IRS income information into the
student’s FAFSA, either on the initial FAFSA or when making a correction to the FAFSA. The student’s school will use the IRS
information that was transferred in the verification process.
The student
has not yet used the IRS Data Retrieval Tool in FAFSA on the Web, but will use the tool to retrieve and transfer 2012 IRS
income information into the student’s FAFSA once the student has filed a 2012 IRS tax return. See instructions above for information
on how to use the IRS Data Retrieval Tool. The student’s school cannot complete the verification process until the IRS information has
been transferred into the FAFSA.
The student is
unable or chooses not to use the IRS Data Retrieval Tool in FAFSA on the Web, and the student will submit to the
school a 2012 IRS tax return transcript—not a photocopy of the income tax return. To obtain an IRS tax return transcript, go to
www.IRS.gov and click on the “Order a Return or Account Transcript” link, or call 1/800/908-9946. Make sure to request the “IRS tax
return transcript” and not the “IRS tax account transcript.” You will need your Social Security Number, date of birth, and the address
on file with the IRS (normally this will be the address used when the 2012 IRS tax return was filed). It takes up to two weeks for IRS
income information to be available for electronic IRS tax return filers, and up to eight weeks for paper IRS tax return filers.
Check here if the student’s IRS tax return transcript is attached to this worksheet.
Check here if the student’s IRS tax return transcript will be submitted to the student’s school later. Verification cannot be
completed until the IRS tax return transcript has been submitted to the student’s school.
2. TAX RETURN NONFILERS
Complete this section if the student will not file and is
not required to file a 2012 income tax return with the IRS.
Check the box that applies:
The student was not employed and had no income earned from work in 2012.
The student was employed in 2012 and has listed below the names of all the student’s employers, the amount earned from each
employer in 2012, and whether an IRS W-2 form is attached. Attach copies of all 2012 IRS W-2 forms issued to the student by
employers. List every employer even if they did not issue an IRS W-2 form. If more space is needed, attach a separate page with the
student’s name and Social Security Number at the top.
Employer’s Name
2012 Amount Earned
IRS W-2 Attached?
ABC Shipping (example) $1,280 Yes
2
Student Name:
Student ID Number:
D. Parent’s Income Information to Be Verified
Note: If two parents were reported in Section B of this worksheet, the instructions and certifications below refer and apply to both parents.
1. TAX RETURN FILERS
Important Note: If the student’s parent(s), filed or will file, an
amended 2012 IRS tax return the student’s financial aid administrator must
be contacted before completing this section.
Instructions: Complete this section if the student’s parent(s)
filed or will file a 2012 income tax return with the IRS. The best way to verify
income is by using the IRS Data Retrieval Tool that is part of FAFSA on the Web. If the student’s parent(s) has not already used the tool, the
parent and the student should go to
FAFSA.gov, log in to the student’s FAFSA record, select “Make FAFSA Corrections,” and navigate to the
Financial Information section of the form. From there, follow the instructions to determine if the parent(s) is eligible to use the IRS Data
Retrieval Tool to transfer 2012 IRS income tax information into the student’s 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 whether or how to use the IRS Data Retrieval Tool see the student’s financial aid administrator.
Check the box that applies:
The student’s parent has used the IRS Data Retrieval Tool in FAFSA on the Web to transfer 2012 IRS income information into the
student’s FAFSA, either on the initial FAFSA or when making a correction to the FAFSA. The student’s school will use the IRS information
transferred into the student’s FAFSA to complete the verification process.
The student’s parent
has not yet used the IRS Data Retrieval Tool, but will use the tool to transfer 2012 IRS income information into the
student’s FAFSA once the parent’s IRS tax return has been filed. See instructions above for information on how to use the IRS Data
Retrieval Tool. The student’s financial aid administrator cannot complete verification until the parent has transferred IRS information
into the student’s FAFSA.
The parent
is unable or chooses not to use the IRS Data Retrieval Tool, and the parent will submit to the student’s school a copy of the
parent’s 2012 IRS tax return transcript(s)—not photocopies of the income tax return. To obtain an IRS tax return transcript go to
www.IRS.gov and click on the “Order a Return or Account Transcript” link, or call 1-800-908-9946. Make sure youorder the “IRS tax
return transcript” and not the “IRS tax account transcript.” The parent will need his or her Social Security Number, date of birth, and the
address on file with the IRS (normally this will be the address used when the 2012 IRS tax return was filed). It takes up to two weeks for
IRS income information to be available for electronic IRS tax return filers, and up to eight weeks for paper tax return filers. If the parents
are married, and separate 2012 tax returns were filed, 2012 IRS tax return transcripts must be submitted for each parent.
Check here if an IRS tax return transcript(s) is attached to this worksheet.
Check here if IRS tax return transcript(s) will be submitted to the student’s school later. Verification cannot be completed until
the IRS tax return transcript(s) has been submitted to the school.
2. TAX RETURN NONFILERS
Complete this section if the student’s parent(s) will not file and
is not required to file a 2012 income tax return with the IRS.
Check the box that applies:
The parent(s) was not employed and had no income earned from work in 2012.
The parent(s) was employed in 2012 and has listed below the names of all the parent’s employers, the amount earned from each
employer in 2012, and whether an IRS W-2 form is attached. Attach copies of all 2012 IRS W-2 forms issued to the parent(s) by
employer(s). List every employer even if they did not issue an IRS W-2 form. If more space is needed, attach a separate page with the
student’s name and Social Security Number at the top.
Employer’s Name 2012 Amount Earned For Whom? IRS W-2 Attached?
Pro Auto $980 Father Yes
3
Student Name:
Student ID Number:
E. Parent’s Other Information to Be Verified
1. Complete this section if someone in the student’s parent’s household (listed in Section B) received benefits from the Supplemental
Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2011 or 2012 calendar years.
One of the persons listed in Section B of this worksheet received SNAP benefits in 2011 or 2012. If asked by the student’s school, I will
provide documentation of the receipt of SNAP benefits during 2011 and/or 2012.
2. Complete this section if one of the student’s parents paid child support in 2012.
One (or both) of the student’s parents listed in Section B of this worksheet paid child support in 2012. The parent has indicated below
the name of the person who paid the child support, the name of the person to whom the child support was paid, the names of the
children for whom child support was paid, and the total annual amount of child support that was paid in 2012 for each child. If asked by
the school, I will provide documentation of the payment of child support. If you need more space, attach a separate page that includes
the student’s name and Social Security Number at the top.
Name of Person Who Paid
Child Support
Name of Person to Whom
Child Support was Paid
Name of Child for Whom Support
Was Paid
Amount of Child Support
Paid in 2012
Joe Jones Jane Doe Jake Jones $6,000
F. High School Completion Status
You must submit documentation of high school completion or an equivalent along with this worksheet.
Check the box of the document you will attach to this worksheet:
High school diploma or high school transcript including graduation date.
Official documentation from high school counselor stating your graduation date and reason why high school diploma/transcript is
unavailable.
General Education Development (GED) Certificate.
State certificate stating you have passed a State-authorized examination recognized as an equivalent of a high school diploma.
Academic transcript of a successfully completed two-year program acceptable for full credit toward a bachelor’s degree.
If you are a homeschooled student, a transcript or equivalent, signed by parent or guardian, listing secondary school courses you have
completed and documentation that you have successfully completed secondary school education.
If you are a homeschooled student, a secondary school completion credential provided under State law.
4
Student Name:
Student ID Number:
G. Documentation of Identity/Statement of Educational Purpose
In order to complete the Verification process, you will need to appear in person at your postsecondary institution and present your
government issued ID (such as a driver’s license, military ID, passport, etc.) and this verification worksheet to an institutionally authorized
financial aid administrator. Your financial aid administrator will need to validate the statement below at the time of submission by
maintaining a copy of your photo ID and by providing a signature and date. If you cannot appear in person to submit this worksheet, you
will need to provide a copy of your government issued ID and this worksheet notarized by a public notary.
Statement of Educational Purpose
I certify that I _____________________________ am the individual signing this Statement of Educational Purpose and that the federal
(Print Student’s Name)
student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending
_________________________________________ for 2013-2014.
(Name of Postsecondary Educational Institution)
Student’s Signature and Date
Financial Aid Administrator Signature and Date
Notary’s Certificate of Knowledge
State of
City/County of
on
before me,
personally appeared,
(Notary’s Name)
(printed name of signer)
And provided to me on basis of satisfactory evidence of identification
(Type of government-issued photo ID provided)
To be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal
(Notary Signature)
(Date commission expires)
(Seal)
H. Certification and Signatures
Each person signing this worksheet certifies that all of the information reported on it is complete and correct. The student and one parent
must sign and date.
Student’s Signature
Date
Parent’s Signature
Date
Do not mail this worksheet to the U.S. Department of Education.
Submit this worksheet to the financial aid administrator at your school.
You should make a copy of this worksheet for your records.
WARNING: If you purposely give false or misleading Information on this
worksheet, you may be fined, be sentenced to jail, or both.
5
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Completed 20 July 2020

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