2019–2020 V5 Verification Worksheet
Independent Student
THIS DOCUMENT CANNOT BE FAXED OR EMAILED
Your 2019–2020 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says
that before awarding Federal Student Aid, we may ask you to confirm the information you reported on your FAFSA. To verify that you
provided correct information the financial aid office at your school will compare your FAFSA with the information on this worksheet and
with any other required documents. If there are differences, your FAFSA information may need to be corrected. You must complete and
sign this worksheet, attach any required documents, and submit the form and other required documents to the financial aid office at your
school. YOUR SCHOOL MAY ASK FOR ADDITIONAL INFORMATION. If you have questions about verification, contact your
financial aid office as soon as possible so that your financial aid will not be delayed.
A. Independent Student’s Information
Student’s Last Name Student’s First Name Student’s M.I. Student’s IRSC ID Number
Student’s Street Address (include apt. no.) Student’s Date of Birth
City State Zip Code Student’s Email Address
Student’s Home Phone Number (include area code) Student’s Alternate or Cell Phone Number
B. Independent Student’s Family Information
List below the people in your household. Include:
Yourself.
Your spouse, if you are married.
Your children, if any, if you will provide more than half of their support from July 1, 2019, through June 30, 2020, or if
the child would be required to provide your 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 you.
Other people if they now live with you and you provide more than half of their support and will continue to provide more
than half of their support through June 30, 2020.
Include the name of the college for any household member who will be enrolled at least half time, in a degree, diploma, or
certificate program at a postsecondary educational institution any time between July 1, 2019, and June 30, 2020. If more space
is needed, attach a separate page with your name and IRSC ID at the top.
Full Name
Example (Marty Jones)
Age
Example (28)
Relationship
Example (Wife,
Self)
College
Example (Central University)
Will be Enrolled at
Least Half Time
Example (Yes or No)
Student’s Name: IRSC ID:
C. Independent Student’s Income Information to Be Verified
1. TAX RETURN FILERS—Important Note: If you (or your spouse, if married) filed, or will file, an amended 2017 IRS tax
return, you must contact your financial aid office before completing this section.
Instructions: Complete this section if you, the student, filed or will file a 2017 income tax return with the IRS. The best way to
verify income is by using the IRS Data Retrieval Tool that is part of FAFSA on the Web. If you have not already used the tool,
go to FAFSA.gov, log in to your FAFSA record, select “Make FAFSA Corrections,” and navigate to the Financial Information
section of the form. From there, follow the instructions to determine if you are eligible to use the IRS Data Retrieval Tool to
transfer 2017 IRS income tax information into your FAFSA. It takes up to two weeks for IRS income information to be
available for the IRS Data Retrieval Tool for electronic IRS tax return filers, and up to eight weeks for paper IRS tax return
filers. If you need more information about when, or how to use the IRS Data Retrieval Tool see your financial aid office. Note:
You cannot use the tool if you are married filing separately.
Check the box that applies:
I, the student, have used the IRS Data Retrieval Tool in FAFSA on the Web to transfer my (and, if married, my spouse’s)
2017 IRS income information into my FAFSA, either on the initial FAFSA or when making a correction to the FAFSA.
Your school will use the IRS information that was transferred in the verification process.
I, the student, have not yet used the IRS Data Retrieval Tool, but I will use the tool to transfer my (and, if married, my
spouse’s) 2017 IRS income information into my FAFSA once I have filed my 2017 IRS tax return. See instructions above
for information on how to use the IRS Data Retrieval Tool. Your school cannot complete the verification process until your
(and, if married, your spouse’s) IRS information has been transferred into your FAFSA.
I, the student, am unable or choose not to use the IRS Data Retrieval Tool in FAFSA on the Web, and I will submit to the
school 2017 IRS tax return transcript(s)—not photocopies of the income tax return. To obtain an IRS tax return
transcript, go to www.IRS.gov and click on the “Order a Return or Account Transcript” link. Make sure to request the
“IRS Tax Return transcript” and not the “IRS Tax Account transcript.” You will need your Social Security Number, date
of birth, and the address on file with the IRS. (Typically this will be the address used when the 2017 IRS tax return was
filed.) It takes up to two weeks for IRS income information to be available for electronic IRS tax return filers, and up to
eight weeks for paper IRS tax return filers.
Check here if an IRS tax return transcript(s) is attached to this worksheet.
Check here if IRS tax return transcript(s) will be submitted to your school later. Verification cannot be completed
until the IRS tax return transcript(s) has been submitted to your school.
2. TAX RETURN NONFILERS—Complete this section if you, the student (and, if married, your spouse), will not file and are
not required to file a 2017 income tax return with the IRS.
Check the box that applies:
The student (and, if married, the student’s spouse) was not employed and had no income earned from work in 2017.
The student (and/or the student’s spouse if married) was employed in 2017 and has listed below the names of all
employers, the amount earned from each employer in 2017, and whether an IRS W-2 form is attached. Attach copies of all
2017 W-2 forms issued to you (and, if married, to your spouse) by employers. List every employer even if the employer did
not issue an IRS W-2 form. If more space is needed, attach a separate page with your name and SSN at the top.
Employer’s Name
Example (Suzy’s Auto Body Shop)
2017 Amount Earned
Example $2,000.00
IRS W-2 Attached?
Example (Yes or No)
Student’s Name: IRSC ID:
D. Independent Student’s Other Information to Be Verified
1. Complete this section if someone in the student’s household (listed in Section B) received benefits from the Supplemental
Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2016 or 2017 calendar years.
YOU MAY BE REQUIRED TO PROVIDE DOCUMENTATION OF SNAP BENEFITS RECEIVED.
One of the persons listed in Section B of this worksheet received SNAP benefits in 2016 or 2017. If asked by my school, I
will provide documentation of the receipt of SNAP benefits during 2016 and/or 2017.
Name of person receiving benefits: Total amount received:
2. Complete this section if you or your spouse, if married, paid child support in 2017.
Either I, or (if married) my spouse who is listed in Section B of this worksheet, paid child support in 2017. I have indicated
below the name of the person who paid the child support, name of the person to whom the child support was paid, names
of the children for whom child support was paid, and the total annual amount of child support that was paid in 2017 for
each child. YOU MAY BE REQUIRED TO PROVIDE DOCUMENTATION OF CHILD SUPPORT PAID. If you
need more space, attach a separate page that includes your name and IRSC ID at the top.
Name of Person Who Paid
Child Support
Example (Marty Jones)
Name of Person to Whom Child
Support was Paid
Example (Chris Smith)
Name of Child for Whom
Support Was Paid
Example (Terry Jones)
Amount of Child
Support Paid in
2017
Example ($6,000)
E. Identity and Statement of Educational Purpose (To be Signed at the Institution)
The student must appear in person at Indian River State College to verify his or her identity by presenting a valid
government-issued photo identification (ID), such as, but not limited to, a driver’s license, other state-issued ID, or
passport. The IRSC employee will make a copy of the student’s photo ID that is annotated with the date it was
received and the name of the official at the institution authorized to collect the student’s ID.
In addition, the student must sign, in the presence of an IRSC employee, the following:
Statement of Educational Purpose
I certify that I, (Print Student’s Name)
am the individual signing this Statement of Educational Purpose and that the federal student financial
assistance I may receive will only be used for educational purposes and to pay the cost of attending Indian
River State College for 2019-2020.
Student’s Signature Date
click to sign
signature
click to edit
NOTARIZED STATEMENT IS ONLY NECESSARY IF STUDENT CANNOT APPEAR IN PERSON
(copy of Driver’s License, US Passport, or other picture ID must accompany this form if signed by a notary)
Notary’s Certificate of Acknowledgement
State of
City/County of
On (Date) ,
before me, (Notary’s name) ,
personally appeared, (Printed name of signer) ,
and provided to me on basis of satisfactory evidence of identification
(Type of government-issued photo ID provided)
to be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal
(seal) (Notary signature)
My commission expires on
(date)
F. Certification and Signatures
Each person signing this worksheet certifies that all of the
WARNING: If you purposely give false or misleading
information reported on it is complete and correct.
information on this worksheet, you may be fined, be sentenced
to jail, or both.
The student and one parent must sign and date.
Student’s Signature Date
Parent’s Signature Date
Do not mail this worksheet to the U.S. Department of
Education. Submit this worksheet to the financial aid
office at your school. You should make a copy of this
worksheet for your records.
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome