Secure submission of documents can be completed in person, by mail, or fax to:
Office of Financial Aid and Scholarships · Roger Rook Hall · 19600 Molalla Avenue, Oregon City, OR 97045
Phone: 503-594-6082 · Fax: 503-722-5864 · e-mail: finaid@clackamas.edu · www.clackamas.edu
02/21/19 tms
2019-2020 Dependent
V1 Standard Verification Worksheet
Your FAFSA application has been selected for a process called verification. Please complete all parts of this worksheet and return to the Financial Aid
Office. Notice: incomplete forms may delay processing.
B. Household Information – List the members in your parents’ household. Attach an additional sheet if necessary.
Please include: yourself, even if you don’t live with your parents, your parents/step-parent (if your parent is remarried you must include your step-
parent), your parents’ other children (even if they do not live with your parents), siblings, and individuals who will receive more than half of their
support from your parents between July 1, 2019 and June 30, 2020.
Enrolled in College
at least half-time
(check one)
Clackamas Community College
[This does not apply to parent/step parent]
[This does not apply to parent/step parent]
C. Tell us about your 2017 tax filing status –
Student’s Filing Status (select only one)
□ I filed my 2017 return and successfully used the IRS Data
Retrieval Tool via the FAFSA. Tax transcript not required.
□ I filed my 2017 return and chose not to or, I am unable to use
the IRS Data Retrieval Tool. Submit your 2017 IRS Tax
Return Transcript.
□ I amended my taxes after originally filing my 2017 return
and will submit:
o 2017 IRS Tax Return Transcript
o 2017 Signed IRS 1040X form
□ I did not and I am not required to file a federal tax return. I
was not employed and earned no income from work in 2017.
□ I did not and I am not required to file a federal tax return. In
2017, I earned income from the source(s) listed below:
Submit 2017 IRS Verification of Non-filing Letter*
Employer’s Name
2017 Earned
Amount
IRS W-2/1099
Attached
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
Attach all W-2s and/or 1099s issued to you in 2017
*IRS Verification of Non-Filing Letters can be requested online or by checking
box 7 and 8 (if no W-2s provided) on IRS Form 4506-T. Notice: 2017 IRS
Verification of Non-Filing Letters must be dated on or after October 1, 2018.
Parent(s) Filing Status (select only one)
□ My parent(s) filed their 2017 return and successfully used
the IRS Data Retrieval Tool via the FAFSA. Tax transcript
not required.
□ My parent(s) filed their 2017 tax return and chose not to or,
were not able to use the IRS Data Retrieval Tool. Submit
parent’s 2017 IRS Tax Return Transcript.
□ My parent(s) amended their taxes after originally filing
their return and will submit:
o 2017 IRS Tax Return Transcript
o 2017 Signed IRS 1040X form
□ My parent(s) did not and is/are not required to file a federal
tax return. My parent(s) were not employed and earned no
income from work in 2017. Submit 2017 IRS Verification of
Non-filing Letter
□ My parent(s) did not and is/are not required to file a federal
tax return. In 2017, my parent(s) income from the source(s)
listed below: Submit 2017 IRS Verification of Non-filing Letter
Employer’s Name
2017 Earned
Amount
IRS W-2/1099
Attached
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
Attach all W-2s and/or 1099s issued to your parent(s) in 2017
D. Certification and Signatures – Each person signing this worksheet certifies that all of the information reported on it is complete
and correct. The student and one parent whose information was reported on the FAFSA must sign and date. Warning! If you
purposely give false or misleading information you may be fined, sentenced to jail, or both.
Student Signature: _____________________________________________________ Date: ___________________
Parent Signature: ______________________________________________________ Date: ___________________
This worksheet must be signed and dated to be valid. Electronic and/or digital signatures are not valid.
Student’s Name: ____________________________ Date of Birth ___________ CCC ID: _______________
