Fillable 2019-2020 Dependent Verification Worksheet (Grays Harbor College)

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2019-2020 Dependent Verification Worksheet (Grays Harbor College)

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Financial Aid Office, 1620 Edward P Smith Dr, Aberdeen, WA 98520
www.ghc.edu/finaid (360) 538-4081 Fax: (360) 538-4293 finaid@ghc.edu
Revised: 02/19/2019
2019-2020 Dependent Verification Worksheet
Your 2019-20 FAFSA was selected for review in a process called verification. Federal Regulations say that before
awarding Federal Student Aid, we must ask you to confirm the information you reported on your FAFSA. In this process,
the Financial Aid Office will compare your FAFSA with the information on this worksheet and any other required
documents. If there are differences, we may need to correct your FAFSA. You must complete and sign this worksheet,
attach required documents and submit them to the Financial Aid Office in order to be considered for financial aid funding.
Additional information may be required by the Financial Aid Office.
DO NOT LEAVE BLANK- READ AND COMPLETE ALL SECTIONS!
1. Student Information
Last Name First Name M.I. SSN
2. Household Chart
Use each chart below to list the people who are or will be in your parent(s)’ household from July 1, 2019 through June
30, 2020.
2.a
Yourself, even if you don’t live with your parent(s)
Your parent(s) (this includes a stepparent)
o If your parents are living together but are not married to each other, list both
Full Name Age Relationship Name of College (if attending)
Will be Enrolled at Least
Half Time in College
self
Grays Harbor College
Yes
No
Parent 1
Yes
No
Parent 2
Yes
No
2.b
Your parent(s)’ other children, if your parent(s) 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 they do not live
with your parent(s).
Full Name Age Relationship Name of College (if attending)
Will be Enrolled at Least
Half Time in College
Sibling 1
Yes
No
Sibling 2
Yes
No
Sibling 3
Yes
No
Sibling 4
Yes
No
Sibling 5
Yes
No
2.c
Other people if they now live with your parent(s), AND your parent(s) provide more than half of their support and
will continue to provide more than half of their support through June 30, 2020.
Full Name Age Relationship Name of College (if attending)
Will be Enrolled at Least
Half Time in College
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
5D
3. 2017 Income Information
Instructions for 2017 Tax Filers: Check the appropriate box below for both the Student and Parent. The best
way to verify income is by using the IRS Data Retrieval Tool (DRT) that is part of FAFSA.
Student
I used the IRS Data Retrieval Tool (DRT) on the FAFSA.
I am attaching my 2017 IRS Tax Return Transcript. See
Step 4 for Instructions on obtaining a Tax Transcript.
I am attaching a signed copy of my 2017 Tax Return.
I filed an amended 2017 Tax Return.
If you select this option you must submit a signed copy of
your 1040X and a Tax Return Transcript or a signed copy
of your 2017 Tax Return.
Parent
I used the IRS Data Retrieval Tool (DRT) on the FAFSA.
I am attaching my 2017 IRS Tax Return Transcript. GHC
will not accept copies of tax returns.
I am attaching a signed copy of my 2017 Tax Return.
I filed an amended 2017 Tax Return.
If you select this option you must submit a signed copy of
your 1040X and a Tax Return Transcript or a signed copy
of your 2017 Tax Return.
Instructions for 2017 Non-tax Filers:
Complete this section if the student or parent(s) will not file and are not required to file a 2017 Income Tax Return
with the IRS. See step 4 for options on requesting a 2017 Verification of Non-Filing Letter.
Student
Non-Filing Status
I did not or was not required to file a 2017 Tax
Return.
2017 Earnings Information (Select one option)
I did not have earnings in 2017.
I had earnings in 2017. You must list your employer(s) and
income earned below AND attach W-2 form(s). All
W-2 forms must be provided.
Parent
Non-Filing Status (Select one option)
I am attaching my IRS Letter of Non-Filing Status
because I did not or was not required to file a 2017
Tax Return.
I am unable to obtain an IRS Letter of Non-Filing
Status and have attached documentation (i.e. screen
shots) that verifies I have attempted to access the
Letter of Non-Filing Status from the IRS website.
2017 Earnings Information (Select one option)
I did not have earnings in 2017.
I had earnings in 2017. You must list your employer(s)
and income earned below AND attach W-2 form(s). All
W-2 forms must be provided.
4. IRS Tax Transcript or Verification of Non-filing Letter Request Options
• Get a Transcript either ONLINE or by MAIL – Go to www.irs.gov, click “Get Your Tax Record”. Click
“Get Transcript Online” or “Get Transcript by Mail”.
o You must use the form 4506T if your address has changed since you last filed.
• Automated Telephone Request – 1-800-908-9946 (Only primary taxpayer on return can use this option)
5. Student – Identity Verification (Check the appropriate box)
I am appearing in-person with valid, unexpired government-issued photo ID (such as a driver’s license, state
identification card, military ID or passport). The financial aid office will make a copy.
I am attaching a copy of my valid, unexpired government-issued photo ID (such as a driver’s license, state
identification card, military ID or passport) that is acknowledged in the notary statement in section 7.
Employer
Earnings/Income
Employer
6. High School Completion Status (Check the correct box and provide the required documentation)
High School Diploma: Attach a copy of your high school diploma or high school transcript indicating your graduation
date.
GED: Attach a copy of your GED certificate or GED transcript.
Home School Graduate: Attach a copy of your home school completion transcript (or equivalent), signed by your
parent/guardian.
Copy of your high school transcript AND a signed statement from your high school counselor stating that,
although you didn’t graduate, you did excel academically in high school.
Copy of college transcript showing successful completion of at least a 2-year program fully acceptable toward a
bachelor’s degree.
7. Student – Statement of Educational Purpose (Check the appropriate box and follow the instructions)
I am appearing in-person to sign the statement below. (Signature MUST be witnessed by a Financial Aid staff
member)
I am unable to appear in-person to submit the statement below and have had the statement notarized.
I certify that I ,___________________________ am the individual signing this Statement of Educational Purpose and that the
(student’s name)
federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending
Grays Harbor College for 2019 – 2020.
FAO
Stude
nt Signature______________________________ Date_______________ Verification
Nota
ry’s Certificate of Acknowledgement
Stat
e of_________________________________ City/County of __________________________________________________
On _________
____________, before me, ______________________________________________________________________,
(Date) (Name of Notary)
Pers
onally appeared, ___________________________________________, and provided to me on basis of satisfactory evidence
(Printed name of signer)
of iden
tification____________________________________________ to be the above-named person who signed the foregoing
(Type of unexpired government-issued photo ID provided)
instru
ment.
WITN
ESS my hand and official seal:
_____________
___________________________________
(Notary’s Signature) (seal)
My co
mmission expires on __________________________
(date)
8. Certification and Signatures
Each person signing this worksheet certifies that all of the information reported on
it is complete and correct. The student and parent must sign and date this
worksheet.
Student Signature Date
Parent Signature (Required for Dependent Students) Date
WARNING: If you purposely give false or misleading information
on this worksheet, you may be fined, sentenced to jail, or both.
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2019-2020 Dependent Verification Worksheet (Grays Harbor College)

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Completed 27 July 2020

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