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 InformationList 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.
Full Name
Relationship to Student
Age
Enrolled in College
at least half-time
(check one)
College
Self
Yes
Clackamas Community College
Parent/Step parent
[This does not apply to parent/step parent]
Parent/Step parent
[This does not apply to parent/step parent]
Sibling/Other: ______
Yes
Sibling/Other: ______
Yes
Sibling/Other: ______
Yes
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.
A. Student Information
Student’s Name: ____________________________ Date of Birth ___________ CCC ID: _______________
Office of Financial Aid and Scholarships
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
02/19/19 tms
Page2
Verification is a process that compares the information you reported on your FAFSA to federal income tax and
other information. It is important to know that your selection for verification does not necessarily mean that there
is incorrect information on your FAFSA. The Department of Education selects students for verification
randomly, and schools like Clackamas Community College (CCC) are required to complete the review before
awarding financial aid.
If you are selected for verification, CCC will request documentation from you necessary to complete the
verification process.
To be eligible for most types of financial aid, verification must be completed before the end of the term for which
you are applying for financial aid so the financial aid offer can be created, accepted and loans originated with the
US Department of Education. However, if you are eligible for the Federal Pell Grant, the deadline for
completing verification for the Federal Pell Grant only is 120 days after the end of the term for which you are
applying for financial aid. There is a final deadline for Pell grant payments in September 2020 that has not been
published by the US Department of Education at the time of this publication. Failure to submit all verification
materials by these deadlines will result in no financial aid being awarded to you and you will be responsible for
any balance incurred at CCC. See Financial Aid Deadlines Calendar.
To ensure timely disbursement of your financial aid, we recommend that you submit all documentation to us as
early as possible, but no later than the following dates:
Term
Recommended Deadline
Term
Recommended Deadline
Summer Term 2019
April 15, 2019
Winter Term 2020
September 30, 2019
Fall Term 2019
June 24, 2019
Spring Term 2020
January 6, 2020
Verification begins with our office collecting a few forms and tax documents from you, and possibly your family,
to confirm the information reported on your FAFSA. All information collected by our office is stored
electronically with restricted access to ensure your information is private and secure throughout the review
process.
As we continue the process, our staff may need additional or followup information from you. This is normal and
may simply be the result of unclear or conflicting information that requires resolution. Because each student is
unique, we never know exactly what each verification will entail until we begin reviewing your documents.
These requests are made through Self-Service and your myClackamas student email, so please check your
account frequently.
If you have unique tax situations such as having a current extension to file your 2017 taxes, you filed an amended
2017 tax return, you are a victim of IRS tax-related identify theft that impacted your 2017 taxes or you file a tax
return in a country other than the US, please contact our office at finaid@clackamas.edu for additional guidance.
To obtain a copy of your Tax Return Transcript or Verification of Non-Filing Letter go to www.IRS.gov
If you are having issues with this process contact us at finaid@clackamas.edu for other options.
Verification Information
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