Fillable 2019-20 Dependent Verification Worksheet (Lehigh Carbon Community College)

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2019-20 Dependent Verification Worksheet (Lehigh Carbon Community College)

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OFFICE OF FINANCIAL AID
4525 Education Park Drive, Schnecksville, PA 18078
P 610
.799.1133| F 610.799.1798
E finaid@mymail.lccc.edu
2019-20 Dependent Verification Worksheet
Your 2019-20 Free Application for Federal student Aid (FAFSA) was selected for the verification review process. This
requires us to compare the FAFSA information with information reported on this institutional verification document
and any other required documents. If there are differences, your FAFSA information must be corrected.
You and your parent(s) whose information was reported on the FAFSA must complete and sign this institutional
verification document, attach any other required documents and submit this form and the other required documents
to the Office of Financial Aid at Lehigh Carbon Community College within 15 days. Failure to complete and return
this information will result in a delay of the processing of your financial aid.
Student Name ID#
Household Information:
List all people within your household from July 1, 2019, through June 30, 2020. This should include:
√ Yourself (the student)
√ Your parent(s) including stepparent(s) even if the student doesn’t live with the parents.
√ Your parents’ other children if your parents will provide more than half of their support from July 1, 2019 through
June 30, 2020 or if the other children would be required to provide parental information if they were
completing a FAFSA for 2019-2020. Include children who meet either of these standards even if the children do
not live with the parents.
√ Other people who live with your parents and your parents provide more than half of their support and will
continue to provide more than half of their support through June 30, 2020.
√ Any household member, excluding the parents, who will be enrolled at least half time in a degree or certificate
program at an eligible postsecondary educational institution any time between July 1, 2019 and June 30, 2020,
include the name of the college.
Full Name
AGE
Relationship
Name of College/Degree program
(if at least half-time during 2019-2020)
Self
Lehigh Carbon Community College
Student: Did you file a 2017 U.S. Federal Tax Return?
If Yes:
Choose One:
I used the IRS Data Retrieval Tool when I filed my FAFSA.
I have a signed copy of my 2017 Tax Return or my 2017 IRS Tax Return Transcript and will submit now.
□ I do not have a copy of my 2017 Tax Return and have ordered my 2017 IRS Tax Return Transcript from the
IRS and will submit it when it is received.
OFFICE USE: VERFD OVER
___ ______________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
If No:
Choose One:
I did not earn income in 2017 and I am not required to file a 2017 Tax Return.
I did earn income in 2017 but am not required to file a 2017 Tax Return. Attached are my 2017 W-2s
Source of Income (Employer’s Name)
Amount earned in 2017
(fill out only if you did NOT file federal taxes in 2017)
Parent: Did you file a 2017 U.S. Federal Tax Return?
If Yes:
Choose One:
I used the IRS Data Retrieval Tool when I filed my FAFSA.
I have a signed copy of my 2017 Tax Return or my 2017 IRS Tax Return Transcript and will submit now
□ I do not have a copy of my 2017 Tax Return and have ordered my 2017 Tax Return Transcript from the
IRS and will submit it when it is received.
If No:
Choose One:
I did not earn income in 2017 and I am not required to file a 2017 Tax Return. Attached is my 2017 IRS
Verification of Non-filing letter.
I did earn income in 2017 but am not required to file a 2017 Tax Return. Attached are my W2s AND my 2017
IRS Verification of Non-filing letter.
Source of Income (Employer’s Name)
Amount earned in 2017
(fill out only if you did NOT file federal taxes in 2017)
Certifications and Signatures
Each person signing below certifies that all of the
information you may be fined, be sentenced to jail or
information reported is complete and correct.
Print Student’s Name Student’s ID Number
Student’s Signature (Required) Date
Parent’s Signature (Required) Date
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2019-20 Dependent Verification Worksheet (Lehigh Carbon Community College)

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Completed 4 October 2020

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