2018-2019 Verification Worksheet
Federal Student Aid Programs
Your application was selected for review in a process called “verification.” In this process, we are required by federal law (34 CFR, Part 668) to compare the information from
your application with the information provided on this form and with signed copies of your 2016 federal tax transcript (and your spouse’s if you are married, or parent (s)’ if you
are considered dependent for federal aid process). We cannot process your financial aid until verification has been completed, so please provide the required documents as
soon as possible.
Complete this form front and back and provide the required signatures (yours and your parents(s)’, if applicable).
Submit completed form to SOWELA Enrollment Services One Stop Center.
A. STUDENT INFORMATION
Last Name First Name M.I. Social Security Number or ID DOB
Check ONE box below
DEPENDENT STUDENT: INDEPENDENT STUDENT:
List the people in your household. Include Yourself plus:
List the people in your parent(s)’ household. Include:
Yourself PLUS:
Your custodial parent(s) (include step -parent)
Your custodial parent(s)’ dependent children
Other people only if they now live with your parents, andyour
parents provide more than half of their support and will
continue to provide through June 30, 2019
Age
Relationship
Self
Mother/Stepmother
Father/Stepfather
Parent’s Dependent Child
Parent’s Dependent Child
Parent’s Dependent Child
Your spouse, if married
Your dependent children, if you will provide more than half of
their support from 7/1/2018 6/30/2019.
Other people if they now live with you, and you providedmore
than half of their support and will continue to provide more
than half of their support through June 30, 2019
Full Name
Age
Relationship
Self
Spouse
Your Dependent Child
Your Dependent Child
Your Dependent Child
Your Dependent Child
**
**If you list others in your household (besides your spouse/dependent children or your parent’s spouse/dependent children) you MUST supply
proof that you provide more than half the support for that person(s)
NUMBER IN COLLEGE: Include in the space below information about any household member that is listed above 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, 2018, and June 30, 2019, and include the name of the college. NOTE: SOWELA may require additional documentation if there is
reason to believe that the information regarding the household members enrolled in eligible postsecondary educational institution is
inaccurate.
FULL NAME
AGE
RELATIONSHIP
COLLEGE
WILL BE ENROLLED AT
LEAST HALF TIME (YES
OR NO)
SELF
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FOR DEPENDENT STUDENTS
Parent(s): (Check one box only)
Check and attach signed 2016 federal tax transcript.
Check if you used the IRS Data Retrieval on the FAFSA
and have not made any changes.
Check if you will not file and are not required to file a
Student’ s Na
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FOR INDEPENDENT STUDENTS
Spouse: (if married) (Check one box only)
Check and attach signed 2016 federal tax transcript.
Check if you used the IRS Date Retrieval on the FAFSA and
have not made any changes.
Check if you will not file and are not required to file a 2016
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ction C.
B. TAX FORMS AND INCOME INFORMATION
Call the IRS at 1-800--908-9946 or at www.irs.gov and request 2016 IRS Tax Return Transcript(s)
Student: (Check one box only)
Check and attach 2016 tax transcript.
Check if you used the IRS Data Retrieval on the FAFSA and have not made any changes.
Check here if you will not file and are not required to file a 2016 U.S. Income Tax Return Complete Section C.
C. 2016 N on-Tax Filers to Be Verified
STUDENT:
1.
NON-TAX FILERSComplete this section if the student, will not file and is not required to file a 2016 income tax return with the IRS.
The independent student (and spouses if applicable) must submit a “Confirmation of Non-filing Letter” from the IRS dated on or
after October 1, 2017.
This letter may be obtained by checking box 7 on IRS Form 4506-T. The form is located online at the following
link https://www.irs.gov/pub/irs-pdf/f4506t.pdf and must be submitted to the IRS for processing. (Instructions are noted on the form).
Check the box that applies:
The student and/or spouse were not employed and had no income earned from work in 2016 therefore W2’s or equivalent documents were not
issued. All applicable untaxed income was reported in section D of this form.
The student and/or spouse were employed in 2016 and has listed below the names of all employers, the amount earned from each employer
in 2016, and whether an IRS W-2 form is attached. Attach copies of all 2016 IRS W-2 forms issued to the student and 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 Name
2016 Amount Earned
IRS W-2 Attached?
Suzy’s Auto Body Shop (example)
$2,000.00(example)
Yes(example)
PARENT:
2.
NON-TAX FILERS—Complete this section if the student’s parent(s) will not file and is not required to file a 2016 income tax return with
the IRS. Parent(s) must submit a “Confirmation of Non-filing Letter” from the IRS dated on or after October 1, 2017. This letter may
be obtained by checking box 7 on IRS Form 4506-T. The form is located online at the following link https://www.irs.gov/pub/irs-
pdf/f4506t.pdf and must be submitted to the IRS for processing. (Instructions are noted on the form).
Check the box that applies:
The parent was not employed and had no income earned from work in 2016 therefore W2’s or equivalent documents were not issued. All
applicable untaxed income was reported in section D of this form.
The parent(s) were employed in 2016 and has listed below the names of all the parent’s employers, the amount earned from each employer
in 2016, and whether an IRS W-2 form is attached. Attach copies of all 2016 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
2016 Amount Earned
IRS W-2 Attached?
Suzy’s Auto Body Shop (example)
$2,000.00 (example)
Yes (example)
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D. 2016 A DDITIONAL FINANCIAL INFORMATION AND UNTAXED INCOME:
Both tax filers and non-tax filers must list any untaxed income received in 2016. Enter zeros if no funds were received.
Student (spouse)
Calendar Year 2016
Parent(s)
(step-parent)
$
Education credits (American Opportunity Tax Credit and Lifetime Learning Tax Credit)
from IRS Form 1040-line 50 or 1040A-line 33.
$
$
Child support paid because of divorce or separation or as a result of legal requirement.
Don’t include support for children in your or parents’ household, as reported in question
73 or 95
$
$
Taxable earnings from need-based employment programs, such as Federal Work-Study and
need-based employment portions of fellowships and assistantships.
$
$
Taxable college grant and scholarship aid reported to the IRS as income. Includes
AmeriCorps benefits (awards, living allowances and interest accrual payments), as
well as grant and scholarship portions of fellowships and assistantships.
$
$
Combat pay or special combat pay. Only enter the amount that was taxable and included in
your adjusted gross income. Don’t include untaxed combat pay.
$
$
Earnings from work under a cooperative education program offered by a college.
2016 Untaxed Income
$
$
Payments to a tax-deferred pension and savings plans(paid directly or withheld from
earnings), including, but not limited to, amounts reported on the W-2 forms in Boxes 12a-
12d, codes D, E, F, G, H, and S. Don’t include amounts reported in code DD(employer
contributions toward employee health benefits).
$
$
IRA deductions and payments to self-employed SEP, SIMPLE, Keogh and other qualified
plans from IRS Form 1040-line 28 + line 32 or 1040A-line 17.
$
$
Child Support received for all children. Don’t include foster or adoption payments.
$
$
Tax exempt interest income from IRS Form 1040-line 8b or 1040A-line 8b.
$
$
Untaxed portions of IRA distributions from IRS Form 1040 (15a minus 15b) or 1040A-
lines (11a minus 11b). Exclude rollovers. If negative, enter a zero here.
$
$
Untaxed portions of pensions from IRS Form 1040-lines (16a minus 16b) or 1040A-lines
(12a minus 12b). Exclude rollovers. If negative, enter a zero here.
$
$
Housing, food, and other living allowances paid to members of the military, clergy, and
others (including cash payments and cash value of benefits).
$
$
Veteran’s non-education benefits such as Disability, Death Pension, or Dependency &
Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances.
$
$
Other untaxed income not reported, such as workers compensation, disability, etc. Also
include the untaxed portions of health savings accounts from IRS Form 1040 Line 25. Don’t
include extended foster care benefits, student aid, earned income credit, additional child tax credit,
welfare payments, untaxed Social Security benefits, Supplemental Security Income, Workforce
Innovation and Opportunity Act educational benefits, benefits from flexible spending
arrangements(ex. Cafeteria plans).
$
$
Money received, or paid on your behalf (e.g. bills), not reported elsewhere on this form.
XXXXXXXXX
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E. FEDERAL BENEFITS- SNAP(FOOD STAMPS), SSI, FREE/REDUCE LUNCH, ETC… CALENDAR YEAR 2016
Title: Compliance Officer
Address: 3820 Senator J . Bennett Johnston Ave, Lake Charles, LA 70616
Telephone No: 337-421-6565 or 800-256-0483
Email: complanceofficer@sowela edu
)
If one of the persons listed in your household that is listed on this worksheet received benefits from SNAP, SSI, WIC, etc…(benefits are listed below) during
the 2016 or 2017 calendar years, please indicate which benefits(s) by placing a check beside all that apply.
Medicaid or Supplemental Security Income (SSI) SNAP (Food Stamps Free/Reduced Price Lunch TANF WIC
F. SIGN THIS WORKSHEET
Each person signing this form certifies that all the information reported on it is complete and correct. I understand that if there are differences
between the FAFSA and verification documents, corrections may be required. The FA office will submit the corrections electronically. If
dependent, at least one parent must sign this form.
Student's Signature Date Parent Signature (if dependent student) Date
WARNING: If you purposely give false or
misleading information on this worksheet, you may
be fined, be sentenced to jail or both.
One Stop Enrollment Center
3820 Sen. J. Bennett Johnston Ave.
Lake Charles, LA 70615
Phone: 337-491-2663
Fax: 337-491-2663
Email: onestop@sowela.edu
www.sowela.edu/financialaid.asp
SOWELA Technical Community College does not discriminate on the basis of race, color, national origin, gender, disability or age
in its programs or activities. The following person has been designated to handle inquiries regarding the non-discrimination policies:
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