Fillable 2019-2020 Independent Student Aggregate Verication Worksheet (Kellogg Community College)

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2019-2020 Independent Student Aggregate Verication Worksheet (Kellogg Community College)

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Financial Aid
450 North Avenue • Battle Creek, MI 49017-3397
269-965-4123 • FAX 269-966-4089
www.kellogg.edu/nancial-aid
KELLOGG
COMMUNITY COLLEGE
2019-2020 Independent Student
Aggregate Verication Worksheet
VI5
READ THIS!
You were selected for VERIFICATION by
the Department of Education. Before
the Financial Aid Oce (FAO) can award
Federal Student Aid, please conrm the
information you reported on your online
2019-2020 FAFSA. A Kellogg Community
College Financial Aid Administrator will
compare the information reported on
your FAFSA with the information on
this worksheet. If there are dierences,
your FAFSA information will need to
be corrected. Complete and sign
this worksheet, attach any required
documents, and submit the form to
the FAO. The FAO may ask for additional
information. If you have any questions
about verication, contact the FAO as
soon as possible so that your nancial
aid will not be delayed.
OPTION 1. IDENTITY & STATEMENT OF EDUCATIONAL PURPOSE
(to be signed at the institution)
The student must appear in person at
to verify his or her identity by presenting an unexpired valid government-issued
photo identication (ID), such as, but not limited to, a driver’s license, other state-
issued ID, or passport. The institution will maintain a copy of the student’s photo
ID that is annotated by the institution with the date it was received and reviewed,
and the name of the ocial at the institution authorized to receive and review the
student’s ID.
In addition, the student must sign, in the presence of the institutional ocial, the
Statement of Educational Purpose provided below.
I certify that I, , am the individual
signing this Statement of Education Purpose and that the federal student nancial
assistance I may receive will only be used for education purposes and to pay the
cost of attending Kellogg Community College for 2019-2020.
Name of Postsecondary Educational Institution
Student Full Name (Please Print)
Student Signature Date
APPROVED
Sta Name
Date
OPTION 2. NOTARY’S CERTIFICATE OF ACKNOWLEDGMENT
If you, the student, are not able to appear in person at Kellogg Community College, to verify your identity, you must
complete and submit this Notarized Certicate of Acknowledgment Statement:
State of City/County of
On , before me, , personally appeared,
and provided to me on basis of satisfactory evidence of identication to be the above named
person who signed the foregoing instrument.
(Today’s Date) (Notary’s Name) (Signer’s Name)
(Type of ID provided)
,
Notary Signature Student Signature
Date Student ID#
My Commission Expires on
(Date)
WITNESS my hand and Ocial Seal:
Part I. INDEPENDENT STUDENT INFORMATION
Last Name First Name M.I. Student ID#
Street Address (include apt. no.) Social Security #
City State Zip Date of Birth
Home Phone Cell Phone Alternative Phone
Part II. HOUSEHOLD INFORMATION
In the box below list ALL members of your household. If you have questions regarding your household members, please contact
the FAO. Your household should include:
• The student
• The student’s spouse, if the student is married.
• The student’s or spouse’s children if the student or spouse will provide more than half of their support from July 1, 2019,
through June 30, 2020, even if the children do not live with the student.
• Other people if they now live with the student and the student or spouse provides more than half of their support and will
continue to provide more than half of their support through June 30, 2020.
Full Name Age
Male or Female
M or F Relationship College
*Will be Enrolled at
Least Half Time
(Yes or No)?
Self Kellogg Community College Yes
Parent
*For any household member who will be enrolled at least half time (6 credits) in a degree, diploma, or certicate program at
an eligible postsecondary educational institution any time between July 1, 2019, and June 30, 2020, include the name of the
college. If more space is needed, provide a separate page with the student’s name and ID number at the top.
NOTE: We may require additional documentation if we have reason to believe that the information regarding the household
members enrolled in eligible postsecondary educational institutions is inaccurate.
Updated 3/19
INDEPENDENT STUDENT AGGREGATE VERIFICATION WORKSHEET VI5 2
Part III. STUDENT INCOME INFORMATION
a. Tax Return Filers — Complete this section if you, the student (and or your spouse, if married), has led or will le a 2017
tax return with the IRS. You have already used the IRS Data Retrieval Tool (DRT), which is part of your FAFSA. For assistance
with using the DRT see instructions on the last page of this worksheet. If you or your spouse have led an Amended 2017 IRS
Federal Tax Return, contact the FAO.
Check the box that applies:
I have led a 2017 Federal IRS Tax Return and have used the DRT through FAFSA
I will le and have NOT yet used the IRS DRT through FAFSA, however I will use the DRT later
I was UNABLE or chose not to use the DRT through FAFSA, and I will submit an IRS Tax Return Transcript separately:
Attach your 2017 Tax Return Transcript to this worksheet
Or Submit Tax Return Transcript at a later date
To obtain an IRS Tax Return Transcript, go to https://www.irs.gov/individuals/get-transcript to request an electronic
transcript or to receive it by mail. You can also call 1-800-908-9946. Make sure to request a Tax Return Transcript and
NOT the Account Transcript
I have led an amended tax return (1040X) and will attach to this worksheet or submit at a later date.
b. Tax Return Non-lers — Only Select One option. Complete this section if you, the student (and, if married, your spouse)
will not le an IRS Tax Return. ALL non-lers must submit a 2017 “IRS Verication of Non-ling Letter” which can be
retrieved from the IRS online at http://www.irs.gov/Individuals/Get-Transcript or by mail by submitting an IRS Form 4506-T,
found at www.irs.gov/pub/irs-pdf/f4506t.pdf
I was not employed, did not have any income earned from working during the year of 2017
-OR-
I was employed however, I was not required to le a 2017 Federal IRS Tax Return. If so, complete the box below and
attach the following:
Attach copies of all 2017 W-2’s and/or 1099 forms
Submit a Household Resources Verication form, found on webpage or at the FAO
Name of Employer Amount Earned in 2017 W-2 Attached? Yes or No
Suzy’s Auto Body Shop (example) $2,000.00 (example) Yes (example)
INDEPENDENT STUDENT AGGREGATE VERIFICATION WORKSHEET VI5 3
Part IV. ADDITIONAL INCOME — Use the table below to report annual amounts for you and your spouse. Be sure to enter
zeros if no funds were received in 2017.
2017 Additional Financial Information Student’s /Spouse Amount
Combat pay or special combat pay. Only enter the amount that was taxable and include in
your adjusted gross income. Combat pay is reported on the W-2 in Box 12, Code Q.
$
Payments to tax-deferred pension and savings plans including, but not limited to, amounts
reported on the W-2 forms in Boxes 12a-12d, Codes D, E, F, G, H and S.
$
Child support RECEIVED for any of your children. Don’t include foster care or adoption
payments. Provide names of child(s) you received child support for:
________________________________________________________________________
________________________________________________________________________
$
Housing, food and other living allowances paid to members of the military, clergy and
others (Including cash payments and cash value of benets.) Don’t include the value of
on-base military housing or the value of a basic military allowance for housing.
$
Veteran’s non-education benets such as disability, Death Pension, or Dependency &
Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances.
$
Other untaxed income not reported in items 45a through 45h or 93a- 93h, such as workers’
compensation, disability, etc. Don’t include student aid, EIC, additional child tax credit,
welfare payments, untaxed SS benets, SSI, WIA educational benets, on-base
military housing or a military housing allowance, combat pay, benets from exible
spending arrangements (e.g. cafeteria plans), foreign income exclusion or credit for
federal tax on special fuels.
$
Money received, or paid on your behalf (e.g. bills), not reported elsewhere on this form. $
Part V. CERTIFICATION AND SIGNATURE
I cerfy that ALL informaon reported on
this worksheet is complete and correct. The
student must sign and date this worksheet. If
married, the spouse’s signature is oponal.
WARNING: If you purposely give false
or misleading information on this work-
sheet, you may be ned, sentenced to jail,
or both.
Student Signature Date
Spouse Signature (optional) Date
RETURN BY MAIL, EMAIL OR FAX TO:
Kellogg Community College
Financial Aid Oce
450 North Avenue
Battle Creek, MI 49017
Email: naid@kellogg.edu
Phone: (269) 965-4123
FAX #: (269) 966-4089
INDEPENDENT STUDENT AGGREGATE VERIFICATION WORKSHEET VI5 4
Updated 2/19
ADDITIONAL ASSISTANCE AND INSTRUCTIONS
Using the IRS Data Retrieval Tool
• Access your FAFSA at www.fafsa.gov and log into your account.
• Once logged in, click on the option to “Make FAFSA Corrections” (this will take you to your completed FAFSA information). If
federal taxes have been led, go to the tax information section and update status to “already completed” taxes. Answer the
series of questions that follow. If you answer “no” to each question an option will be provided to “link to IRS”.
• Enter your name and address information EXACTLY as it appears on your 2017 tax form. If the tool can locate tax information,
click the option to “transfer now”. If you need to use the IRS Data Tool for the student, repeat steps in the student section of the
FAFSA. Once you are done make sure to “next” through the rest of the FAFSA and complete the new submission on the “Sign and
Submit” page.
Requesting an IRS Tax Return Transcript
• Go to www.irs.gov , click “Get My Tax Record”. Then choose “Get Transcript Online” or “Get Transcript by Mail.”
• If you already have an account established, you can log in to access your Tax Return Transcript. To “Get Transcript by Mail” simply
chose that option and supply requested the requested information.
• Request can also be made by telephone at (800) 908-9946 or by completing a 4506-T that can be mailed or faxed to the IRS. In
any case make sure that you request the “IRS Tax Return Transcript” and NOT “IRS Account Transcript”. The transcripts requested
by “Get Transcript by Mail”, Phone and 4506-T are received within 10 business days from the IRS’s receipt of your request.
Verication of Non-Filing Letter
• Go to www.irs.gov, click “Get My Tax Record”. Then choose “Get Transcript online”. The “Get Transcript Online” tool is currently
unavailable for new users. If you already have an account established, you can log in to access a Verication of Non-ling letter.
• Request can also be made by telephone at (800) 908-9946 or by completing a 4506-T that can be mailed or faxed to the IRS.
Verication of Non-ling letters requested by phone or 4506-T are generally received within 10 business days from the IRS’s
receipt of your request.
INDEPENDENT STUDENT AGGREGATE VERIFICATION WORKSHEET VI5 5
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Completed 26 July 2020

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