Fillable 2015 2016 Independent Student Verification Worksheet Tracking Group 5 (Golden Gate University)

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2015 2016 Independent Student Verification Worksheet Tracking Group 5 (Golden Gate University)

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2015–2016 Verification W
o
r
ksh
ee
t
Independent Student - Tracking Group V
5
Your 2015-2016 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. Before awarding Federal
Student Aid, you must confirm the information you and your spouse (if married) reported on your FAFSA. We 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 office. Your school may ask for additional information. Additional information maybe required to resolve conflicting information.
A. Independent Student’s Information
Student’s Last Name
Student’s First Name
MI
Student’s SSN or ID Number
Student’s Date of Birth
City
State
Zip
Student’s Email Address
Student’s Phone Number
Student’s Alternate or Cell Phone Number
B. Independent Student’s Family Information
Number of Household Members: List below the people in the student’s household. Include:
The student.
The student’s spouse, if the student is married.
The student’s or spouse’s children if the student or spouse will provide more than half of the children’s support from July 1, 2015, through June
30, 2016, even if the children do not live with the student.
Other people if they now live with the student and the student or spouse provides more than half of the other people’s support and will continue
to provide more than half of their support through June 30, 2016.
Number in College: Please include in the space below information about any household member who is, or will be, enrolled at least half time in a degree,
diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, 2015, and June 30, 2016, include the name
of the college.
If more space is needed, provide a separate page with the student’s name and ID number at the top.
Full
Na
me
Age
Relationship
C
olle
ge
Will be Enrolled
at
Least Half T
i
me
Missy Jones (example)
27 Self
GGU
Yes
Note: We may require additional documentation if we have reason to believe that the information regarding the household members enrolled in eligible
postsecondary educational institutions is inaccurate.
C. Independent Student’s Income Information to Be Verified
1. TAX RETURN FILERS
Important Note: The instructions below apply to the student and spouse, if the student is married. Notify the financial aid office if the student or spouse
filed separate IRS income tax returns for 2014 or had a change in marital status after the end of the 2014 tax year on December 31, 2014.
Instructions: Complete this section if the student and spouse filed or will file a 2014 IRS income tax return(s). The best way to verify income is by using
the IRS Data Retrieval Tool (IRS DRT) that is part of FAFSA on the Web at FAFSA.gov. In most cases, no further documentation is needed to verify 2014
Student Name:
Student ID Number:
income information that was transferred into the student’s FAFSA using the IRS DRT if that information was not changed.
Check the box that applies:
The student has used the IRS DRT in FAFSA on the Web to transfer 2014 IRS income tax return information into the student’s FAFSA.
The student has not yet used
the IRS DRT in FAFSA on the Web, but will use the tool to transfer 2014 IRS income tax return information into the
student’s FAFSA once the 2014 IRS income tax return has been filed.
The student is unable or chooses not to use
the IRS DRT in FAFSA on the Web, and instead will provide the school a 2014 IRS Tax Return
Transcript(s).
A 2014 IRS Tax Return Transcript may be obtained through:
• Online Request - Go to www.IRS.gov
, under the Tools heading on the IRS homepage, click on the “Get Transcript of Your Tax Records”. Click “Get
Transcript ONLINE” or “Get Transcript by MAIL.” Make sure to request the “IRS Tax Return Transcript” and NOT the “IRS Tax Account Transcript.”
• IRS2Go App- Make sure to request the “Return Transcript” NOT the “Account Transcript”
Apple Online Store at https://itunes.apple.com/us/app/irs2go/id414113282?mt=8
Google Play at https://play.google.com/store/apps/details?id=gov.irs
Use the Social Security Number (or the IRS individual taxpayer identification number) and the date of birth of the first person listed on the 2014 IRS
income tax return, and the address on file with the IRS (normally this will be the address used on the 2014 IRS income tax return).
In most cases, for electronic filers, 2014 IRS income tax return information is available for the IRS DRT or the IRS Tax Return Transcript within 2–3 weeks
after the 2014 IRS income tax return has been accepted by the IRS. Generally, for filers of 2014 paper IRS income tax returns, the 2014 IRS income tax
information is available for the IRS DRT or the IRS Tax Return Transcript within 8–11 weeks after the 2014 paper IRS income tax return has been received
by the IRS. Contact the financial aid office if more information is needed about using the IRS DRT or obtaining an IRS Tax Return Transcript.
If the student and spouse filed separate 2014 IRS income tax returns, 2014 IRS Tax Return Transcripts must be provided for both.
Check here if a 2014 IRS Tax Return Transcript(s) is provided.
Check here if a 2014 IRS Tax Return Transcript(s) will be provided later.
2. TAX RETURN NONFILERS
The instructions and certifications below apply to the student and spouse, if the student is married.
Complete this section if the student and spouse will not file and are not required to file a 2014 income tax return with the IRS.
Check the box that applies:
The student and spouse were not employed and had no income earned from work in 2014.
The student and/or spouse was employed in 2014 and have listed below the names of all employers, the amount earned from each
employer in 2014, and whether an IRS W-2 form is provided. Provide copies of all 2014 IRS W-2 forms issued to the student and/or spouse by
their 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
Na
me
2014 Amount
Earned
IRS W-2
Attached?
ABC Shipping (example)
$1,280
Yes
Note: We may require you to provide documentation from the IRS that indicates a 2014 IRS income tax return was not filed with the IRS.
D. Other Information to Be Verified
1. Check the appropriate box below:
2
Student Name:
Student ID Number:
______________________________ __________________________
No one listed in the household received SNAP benefits in 2013 or 2014.
One of the persons listed in household received SNAP benefits in 2013 or 2014.
Note: If we have reason to believe that the information regarding the receipt of SNAP benefits is inaccurate, we may require documentation from the
agency that issued the SNAP benefits in 2013 or 2014.
2. Check the appropriate box below:
No child support was paid for individuals outside of the household in 2014.
The student and/or spouse, who is a member of the student’s household, paid child support in 2014. Provide in the space below the names
of the persons who paid the child support, the names of the persons to whom the child support was paid, the names and ages of the
children for whom child support was paid, and the total annual amount of child support that was paid in 2014 for each child. Do not include
child support paid for children included in the student’s household.
If more space is needed, provide a separate page that includes the student’s name and ID number at the top.
Name of Person Who P
aid
Child
Suppo
r
t
Name of Person to W
ho
m
Child Support was P
aid
Name of Child for Whom
Suppo
r
t
Was P
aid
Amount of Child
Suppo
r
t
Paid in 2014
Joe Jones
Jane Doe
Jake Jones
$6,000
Note: If we have reason to believe that the information regarding child support paid is inaccurate, we may require additional documentation, such as:
• A signed statement from the individual receiving the child support certifying the amount of child support received; or
• Copies of the child support payment checks, money order receipts, or similar records of electronic payment having been made.
E. High School Completion Status
Provide one of the following documents that will indicate the student’s high school completion status when the student begins college in 2015-2016:
Check the box of the document you will attach to this worksheet:
A copy of the Student’s high school diploma.
A copy of the student’s final official high school transcript that shows the date when the diploma was awarded.
A state certificate or transcript received by a student after the student passed a State-authorized examination (GED test, HiSET, TASC, or other
State-authorized examination) that the State recognizes as the equivalent of a high school diploma.
For students who completed secondary education in a foreign country, a copy of the “secondary school leaving certificate” or other similar
document.
An academic transcript that indicates the student successfully completed at least a two-year program that is acceptable for full credit toward a
bachelor’s degree.
For a homeschooled student in a state where state law requires the student to obtain a secondary school completion credential for homeschool
(other than a high school diploma or its recognized equivalent), a copy of that credential.
For a homeschooled student from a state where state law does not require the student to obtain a secondary school completion credential for
homeschool (other than a high school diploma or its recognized equivalent), a transcript or the equivalent, signed by the student's parent or
guardian, that lists the secondary school courses the student completed and includes a statement that the student successfully completed a
secondary school education in a homeschool setting.
A student who is unable to obtain the documentation listed above must contact the financial aid office.
F.
Identity and Statement of Educational Purpose
3
Student Name:
Student ID Number:
______________________________ __________________________
Section F is ONLY to be completed in person at the Institution or in front of a Notary.
The student must appear in person at
(Name of Postsecondary Education Institution)
to verify his or her identity by presenting a valid government-issued photo identification (ID), such as, but not limited to, a driver’s license, other state-
issued ID, or passport. The institution will maintain a copy of the student’s photo ID that is annotated by the institution with the date it was received
and reviewed and the name of the office at the institution authorized to collect the student’s ID. In addition, the student must sign, in the presence of
the institutional official, the Statement of Education Purpose provided below. If you cannot appear in person to sign this Statement of Educational
Purpose, you will need to provide a copy of your government issued ID and this Statement of Educational Purpose notarized by a public notary.
Statement of Education Purpose
I certify that I
am the individual signing this Statement of Educational Purpose and that the
Printed Student’s Name
Federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending
for 2015-2016.
(Name of Postsecondary Educational Institution)
Student’s Signature
Date
Financial Aid Administrator’s Signature
Date
Notary’s Certificate of Knowledge
State of
City/County of
On
before me,
personally appeared,
(Notary’s Name) (printed name of signer)
and proved 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
Each person signing this worksheet certifies that all of the information reported on it is complete and correct. WARNING: If you purposely give
false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
The student must sign and date this form.
Student’s Signature
Date
Spouse’s Signature (optional)
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.
4
2015-16 INCOME/EXPENSE CERTIFICATION (GRANT RECIPIENT)
GGU ID LAST NAME FIRST NAME
Note: You will not be able to save this PDF form; however, you may type on the form and print it out.
STUDENT INCOME (AND SPOUSE) 2014 INCOME INFORMATION
Please list all income and cash support that you received from January 2014 through December 2014. Include untaxed
earnings that are not reported on your federal income tax return (if you are required to file). If you are married, you MUST
list your spouse's income information.
SOURCE OF INCOME ANNUAL AMOUNT
WAGES
SPOUSE/PARTNER WAGES
UNTAXED INCOME
BENEFITS PROGRAM
FINANCIAL AID
PERSONAL BILLS PAID ON MY
BEHALF
VETERANS NONEDUCATIONAL
BENEFITS
TOTAL INCOME
STUDENT (AND SPOUSE) 2014 EXPENSE INFORMATION
Please list all of your expenses from January 2014 through December 2014. If you are married, you MUST list your
spouse's expense information.
MONTHLY AMOUNT ANNUAL AMOUNT
RENT/MORTGAGE
UTILITIES
FOOD
TRANSPORTATION
CLOTHING
ENTERTAINMENT
OTHER
TOTAL EXPNESES
I hereby certify that all the above information is true, complete and correct. I understand that by providing false
information, I may lose financial aid eligibility which may result in my owing GGU for whatever costs I may have
already incurred.
_____________________________________________ ___________________________________________
STUDENT SIGNATURE DATE
Golden Gate University Financial Aid Office Last Revision: 02/19/2015
2015-16 INCOME/EXPENSE CERTIFICATION (GRANT RECIPIENT)
Please select the appropriate box for the following questions:
a) Do you have a parent or guardian that was a member of the armed forces and died as a result of military service in
Iraq or Afghanistan after 9/11/2001?
b) Were you less than 24 years of age or enrolled as a student at an institution of higher education at the time of your
parent/guardian's death?
c) Student who is subject to involuntary civil commitment upon completion of a period of incarceration for a forcible
or non-forcible sexual offense is ineligible to receive a Pell Grant.
Does this apply to you?
*Checking this box will make you ineligible to receive Pell or FSEOG Grants per federal regulations
As an eligible Pell Grant and/or FSEOG recipient, per federal regulations you must complete a review process called
"Verification" to receive your award. If you stated in your FAFSA that you have Zero income, reported very little
income to support yourself and/or your dependent(s), or were otherwise unable to complete on Page 1 of this form,
please explain below how you supported yourself and/or your dependent(s) in the past year:
I hereby certify that the information provided in this document is true and correct. I also understand that I may lose
my eligibility if I give false or misleading information.
____________________________ __________________________ _______________________
Student Name Student Signature Date
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
To be completed by any person or persons who provided in-kind support to the student:
I hereby certify that the above statement is true and that I have provided in-kind support to the above student:
____________________________ __________________________ _______________________
Name Signature Date
(Please attach a copy of the driver's license or signature ID of person who provided in-kind support)
Golden Gate University Financial Aid Office Last Revision: 02/19/2015
Yes
No
*Decline to Answer
Yes
No
*Decline to Answer
Yes
No
*Decline to Answer
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2015 2016 Independent Student Verification Worksheet Tracking Group 5 (Golden Gate University)

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Completed 21 July 2020

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