Fill - Free fillable 2015 VI1 (California Lutheran University) PDF form

California Lutheran University – Office of Financial Aid

15-16

VI1

Independent Verification Worksheet

Federal Student Aid Programs

Your 2015–2016 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. You must complete and

sign this worksheet, attach any required documents, and submit the form and other required documents to the Office of Financial Aid. We may ask

for additional information. Should you require further instructions, please contact our office at (805) 493-3115 or finaid@callutheran.edu.

A. Student Information

Last Name

First Name

M.I.

CLU ID # or Social Security Number

@callutheran.edu

Date of Birth

E-mail address

Current phone number (include area code)

B. Number of Household Members and Number in College

List the people in the student’s household, including:

► The student and spouse (if applicable) and

► The student’s or spouse’s children if the student or spouse will provide more than half of their support from July 1, 2015, through June 30,

2016, even if the children do not live with the student and

► Other people if they now live with the student and the spouse, and the student or spouse provides more than half of their support and will

continue to provide more than half of their support through June 30, 2016

First and last name of family member

Relationship to student

Age

Name of COLLEGE family member will attend *

Self

California Lutheran University

* For any family member who 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.

If more space is needed, provide a separate page with the student’s name and ID number at the top.

C. Child Support Paid

1. In 2014, did the student or the student’s spouse make child support payments to another person?

□ YES (please complete chart below)

□ NO

Name of person who made child support

payment(s)

Name of person who received child

support payment(s)

Name of child for whom

child support was paid

Total amount paid between

January 1 - December 31, 2014

If more space is needed, provide a separate page with the student’s name and ID number at the top.

D. Receipt of SNAP Benefits

1. Did any member of the student’s household receive benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known

as the Food Stamp Program) sometime during 2013 or 2014?

□ YES

□ NO

Note: If we have reason to believe that the information regarding the payment of child support and/or receipt of SNAP benefits is inaccurate, we

may require further documentation.

E. Income Verification for 2014

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 IRS income tax return information that was transferred into the student’s FAFSA

using the IRS DRT if that information was not changed. Contact the financial aid office if more information is needed about using the IRS DRT.

Please wait 3 weeks after electronically filing your tax return before using the Data Retrieval Tool or downloading your Return Transcript.

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.

1. Check the box that applies:

□ The student and/or spouse has used or plans to use the IRS DRT in FAFSA on the Web to transfer 2014 IRS income tax return information

into the student’s FAFSA.

(Do NOT send a photocopy of the income tax return)

□ The student and/or spouse is unable to use the IRS DRT in FAFSA on the Web, and instead will provide the school a 2014 IRS Tax Return

Transcript(s). To obtain an IRS Tax Return Transcript, go to www.IRS.gov and click on the “Get Transcript of Your Tax Record” link.

□ The student and/or spouse will not file and are not required to file a 2014 income tax return with the IRS (complete explanation below):

____ Check here if the student and spouse were not employed and had no income earned from work in 2014.

____ Check here if the student and/or spouse were employed in 2014 and list below the names of all employers and the amounts

earned from each employer in 2014. Any student who checks this option must provide copies of all 2014 IRS W-2 forms issued to

the student/spouse by his/her employers. List every employer, even if the employer did not issue a W-2 form. Please note this

option is for students who are not filing a tax return.

Employer’s Name (for non-tax filers only)

Amount earned in 2014

W-2 Provided?

2. In 2014, did any member of the student’s household roll over any portion of an IRA distribution or retirement account?

□ YES (please include a copy of Form 1099 for the rollover)

□ NO

F. Certifications and Signatures

The student must sign and date below. If married, the spouse’s signature is optional. Each person signing below certifies that all of the information

reported is complete and correct. WARNING: If you purposely give false or misleading information you may be fined, be sentenced to jail, or

both.

RETURN TO:

CLU Office of Financial Aid

60 West Olsen Road #1375

Thousand Oaks, CA 91360

EMAIL: finaid@callutheran.edu

FAX: (805) 493-3114

Student’s Signature - Required

Date

Spouse’s Signature

Date

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