Fillable 2013 14 Ind V5 Worksheet (Golden Gate University)

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2013 14 Ind V5 Worksheet (Golden Gate University)

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2013–2014 Verification Worksheet
Independent 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 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 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. Independent 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. Independent Student’s Family Information
List below the people in your household. Include:
• Yourself.
• Your spouse, if you are married.
• Your children, if any, if you will provide more than half of their support from July 1, 2013, through June 30, 2014, or if the child
would be required to provide your 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 you.
• Other people if they now live with you and you 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 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 your name and Social Security Number at the top.
Full Name
Age
Relationship
College
Will be Enrolled at
Least Half Time
Missy Jones (example) 28 Wife Central University
Yes
Self
1
Student ID Number:
C. Independent Student’s Income Information to Be Verified
1. TAX RETURN FILERS
Important Note: If you (or your spouse, if married) 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 you, 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 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.
Check the box that applies:
I, the student,
have used the IRS Data Retrieval Tool in FAFSA on the Web to transfer my (and, if married, my spouse’s) 2012 IRS
income information into my FAFSA, either on the initial FAFSA or when making a correction to the FAFSA. Your school will use the IRS
information that was transferred in the verification process.
I, the student,
have not yet used the IRS Data Retrieval Tool in FAFSA on the Web, but I will use the tool to transfer my (and, if
married, my spouse’s) 2012 IRS income information into my FAFSA once I have filed a 2012 IRS tax return. See instructions above for
information on how to use the IRS Data Retrieval Tool. Your school cannot complete the verification process until the IRS information
has been transferred into your FAFSA.
I, the student, am
unable or chooses not to use the IRS Data Retrieval Tool in FAFSA on the Web, and I 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 an IRS tax return transcript is attached to this worksheet.
Check here if IRS tax return transcript will be submitted to your school later. Verification cannot be completed until the IRS tax
return transcript has been submitted to your school.
2. TAX RETURN NONFILERS
Complete this section if you, the student (and, if married, your spouse), will not file and
are not required to file a 2012 income tax return
with the IRS.
Check the box that applies:
The student (and, if married, the student’s spouse) was not employed and had no income earned from work in 2012.
The student (and/or the student’s spouse if married) was employed in 2012 and has listed below the names of all 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 you (and, if married, to your spouse) 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 your 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 ID Number:
D. Independent Student’s Other Information to Be Verified
1. Complete this section if someone in the student’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 my school, I will provide
documentation of the receipt of SNAP benefits during 2011 and/or 2012.
2. Complete this section if you and/or your spouse paid child support in 2012.
Either I, or if married my spouse who is listed in Section B of this worksheet, paid child support in 2012. I have 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 my
school, I will provide documentation of the payment of child support. If you need more space, attach a separate page that includes
your 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
E. 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.
3
Student ID Number:
F. 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)
G. Certification and Signatures
I certify that all of the information reported on this worksheet is complete and correct. The student must sign and date this worksheet. If
married, the spouse’s signature is optional.
Student’s Signature
Date
Spouse’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.
4
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Completed 20 July 2020

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