2019-2020 Independent Verification Worksheet
Coahoma Community College Office of Financial Aid
3240 Friars Point Road
, Clarksdale, MS 38614
Fax: (662) 627-9871
Email: financialaid@coahomacc.edu
Student’s Last Name Student’s First Name CCC ID or Last 4 of SSN
Student’s Mailing Address Student’s Date of Birth
______________________________________________________ _______________________________
Students City, State, Zip Code Students Phone Number
List your children, yourself, and your spouse (if married). The number of people listed must match household size from 2019-2020 FAFSA.
Full Name
Age
Relationship
College
Will be Enrolled at
Least Half Time?
Coco Tiger (example)
24
Self
Coahoma Community College
Yes
Complete this section if the student filed or will file a 2017 income tax return with the IRS.
The student (and, if married, the student’s spouse) used the IRS Data Retrieval Tool to retrieve and transfer 2017 IRS income
information into the student’s FAFSA.
An IRS tax return transcript is attached to this worksheet. For spouses who do not file Married Filed-Jointly, both tax return
transcripts will be required. Verification cannot be completed until the IRS tax return transcript has been submitted to the school.
To obtain an IRS tax return transcript call 1-800-908-9946.
Complete this section if the student will not file and is not required to file a 2017 income tax return with the IRS.
The student (and, if married, the student’s spouse) was not employed and had no income earned from work in 2017.
The student (and, if married, the student’s spouse) was employed in 2017 but did not file a tax return. Please attach W-2s.
*Note: If the student or spouse does not file taxes, additional income verification may be needed before any aid can be processed. This may or may
not include: Supplemental Nutrition Assistance Program (SNAP) benefits in 2017 or 2018, received child support in 2017, social security/disability
benefits in 2017 or unfiled 2017 W-2s
.
.
Student’s Signature Date
Spouse’s Signature (optional) Date
Non-Discrimination Statement: Coahoma Community College is an equal opportunity institution in accordance with civil rights and does not discriminate on the basis of race, color, national origin, gender, disability, age, or other
factors prohibited by law in any of its educational programs, activities and employment opportunities. The following person has been designated to handle inquiries regarding the non-discrimination policies: Michael Houston, Director
of Human Resources/Coordinator for 504/ADA, Title IX Compliance Officer, Office #A100, Vivian M. Presley Administration Building, 3240 Friars Point Road, Clarksdale, Mississippi 38614, Phone: (662) 621-4853,
Email: mhouston@coahomacc.edu.
WARNING: If you purposely give false or
misleading information on this worksheet, you
may be fined, be sentenced to jail, or both.
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