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2019-20 Verification of Non-Filing Statement
Student ID Number: S
Student Name:
Phone Number:
Please read carefully. Form must be completed in blue or black ink. Failure to accurately complete this form may
result in a delay of processing or change of financial aid eligibility. Additional documentation may be requested.
Verification of student’s tax information or non-filing tax status is required to review a student’s eligibility for federal
student aid. If you have a non-filing status with the Internal Revenue Service (IRS) it is a requirement that the school
collect a Verification of Non-filing letter. If you are unable to obtain the Verification of Non-Filing letter from the
Internal Revenue Service (IRS) you may self-certify by completing this form.
1. I certify that I and/or spouse have not filed and am/are not
(Student’s printed name)
required to file a 2017 federal income tax return.
2. I certify that I and/or spouse have made a good faith effort to
(Student’s printed name)
obtain the Statement of Non Filing, form 4506-T, from the Internal Revenue Service (IRS), but was
unable to.
By signing this document, I certify that the information completed is true and accurate. I understand the purposely providing
false or misleading information could result in criminal prosecution, prison sentence, and/or a fine pursuant to U.S. Criminal
Code and Colorado Criminal Code.
Parent Signature: Date: