Fillable 2015 2016 Independent Student Verification Worksheet Tracking Group 6 (Golden Gate University)

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2015 2016 Independent Student Verification Worksheet Tracking Group 6 (Golden Gate University)

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2015–2016 Verification W
o
r
ksh
ee
t
Independent Student - Tracking Group V
6
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)
28
Spouse
Central University
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.
1
Student Name:
Student ID Number:
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 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.
Tax Return Filers must submit 2014 W-2 forms for any employment or other income received in 2014. Please indicate below the W-2 forms that
will be provided to your institution.
The student had employment income or untaxed income in 2014 and is providing W-2 forms.
The spouse (if married) had employment income or untaxed income in 2014 and is providing W-2 forms.
Neither the student nor spouse had employment income or untaxed income in 2014.
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:
2
Student Name:
Student ID Number:
The student and spouse (if married) were not employed and had no income earned from work in 2014.
The student and/or spouse were 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 attached. Attach copies of all 2014 IRS W-2 forms issued to the student and 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 the
student’s name and Social Security Number at the top.
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. Supplemental Nutrition Assistance Program:
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. Child support paid:
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
Age of Child for Whom
Support was Pad
Amount of Child
Suppo
r
t Paid in 2014
Joe Jones Jane Doe Jake Jones 5 $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.
D. Other Untaxed Income
Complete this section if you or your spouse had untaxed income in 2014.
3
Student Name:
Student ID Number:
______________________________ __________________________
Provide Copies of all 2014 IRS W-2 Forms issued by the employers to the student and spouse.
To determine the correct annual amount for each item: If you paid or received the same dollar amount every month in 2014, multiply that
amount by the number of months in 2014 you paid or received it. If you did not pay or receive the same amount each month in 2014, add
together the amounts you paid or received each month.
If any Item does not apply enter “N/A” where a response is requested or enter “0” if an amount is requested.
Name of Person Who had Untaxed Income
Type of Untaxed Income Received
Student Amount
Spouse Amount
Jim Jones
Money received or paid on the students behalf
$500.00
0
Payments to tax-deferred pension and savings
plans
Housing, food, and other living allowances paid
to members of the military, clergy
Veterans noneducation benefits
Money received or paid on the students behalf
Other untaxed income
Other Untaxed Income includes: Untaxed income not reported elsewhere on this form, workers’ compensation, disability, black lung benefits,
untaxed portions of health savings accounts from IRS Form 1040 line 25, railroad retirement benefits etc.
Do Not include: student aid, earned income credit, additional child tax credit, TANF, untaxed social security benefits, SSI, WIA, combat pay, benefits
from flexible spending arrangements, foreign income exclusion or credit for federal tax on special fuels.
E. Child Support Received
Complete this section if child support was received in 2014 for any children in your household.
Name of Person Who Received Child Support
Name of Child for Whom Support Was Paid
Amount of Child Support Received in 2014
Jim Jones
Josh Jones
$5,000
Do not include foster care payments, adoption payments or any amount that was court ordered but not actually paid.
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 6 (Golden Gate University)

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Completed 21 July 2020

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