Fillable 2020 - 2021 Dependent Verification Worksheet (EDVW21) (East Tennessee State University)

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2020 - 2021 Dependent Verification Worksheet (EDVW21) (East Tennessee State University)

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EAST TENNESSEE STATE
UNIVERSITY
OFFIC
E
OF
Financial
Aid
2020 - 2021 Dependent Verification Worksheet (EDVW21)
Your application for Federal Financial Aid was selected for review in a process called "Verification." In this process, your school may
request documentation regarding your applicable tax filing status, 2018 W-2 forms, and other financial documents. Federal law (34
CFR, Part 668) requires schools to review this information and provides the school with the right to ask for this information before
awarding Federal aid. If there are differences between your application information and your financial documents, the school must
make corrections electronically using your Student Aid Report (SAR). DO NOT EMAIL documents with Personally Identifiable
Information (PII) (i.e. SSN, Full Name, Phone #, Address…).
Please note the IRS Tax Transcript is only needed if you or your parent(s) did not transfer your 2018 income directly from the IRS to
your FAFSA.
A. Dependent Student’s Information
Last Name First Name M.I.
ETSU E-NUMBER
B. Dependent Student’s Number of Household Members and Number in College
Complete each column below with the name, age and relationship of each person that can be included in the household
size, as defined below
:
• Yourself; even if you do not live with your parents
• Your parents; must include biological parents even if not married but living in the same household or a stepparent if the
parent reported on the FAFSA has remarried
• Your parents’ other children; even if they DO NOT live with your parent(s), if (A) your parent(s) will provide more than half
of their support from July 1, 2020 through June 30, 2021, or (B) the children would be required to provide parental
information when applying for Federal Student Aid
• 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 from July 1, 2020 through June 30, 2021. You may be required to
provide proof of support for these individuals.
Full Name
Age
Relationship
Is the household member, except parents, attending at
least halftime in a degree, diploma or certificate
program at an eligible postsecondary educational
institution any time between July 1, 2020 and June 30,
2021? If yes, list the name of the college.
Self
No □ Yes □ East Tennessee State Univ.
No □ Yes □
No □ Yes □
No □ Yes □
No □ Yes □
No □ Yes □
No □ Yes □
Failure to complete every section of this form will result in a delayed financial aid package
Student’s Name:_______________________________________ ETSU E#: E________________
C. Student Tax/Income Information
Did you file a Federal Income Tax Return for 2018? □ Yes □ No
1. If you answered YES, check the box that applies:
□ I have used the IRS Data Retrieval Tool (DRT) to transfer my 2018 IRS information to my FAFSA.
□ I have not yet used the IRS DRT, but will use the tool to transfer 2018 IRS income information to my FAFSA.
□ I am unable or choose not to use the IRS DRT, and I will submit my 2018 IRS Tax Return Transcript.
2. If you answered NO, but worked in 2018, attach all copies of 2018 W-2 forms and complete the table listed
below:
Student Income Source or Employer
(If none, indicate N/A)
2018 Amount Earned (If
none, indicate $0)
W-2 Provided? If no, please explain.
$
□
Yes
□
No ______________________________
$
□
Yes
□
No ______________________________
$
□
Yes
□
No ______________________________
D. Parent Tax/Income Information
Did you (and/or your spouse) file a Federal Income Tax Return for 2018? □ Yes □ No
1. If you answered YES, check the box that applies:
□ I have used the IRS Data Retrieval Tool (DRT) to transfer my 2018 IRS information to my FAFSA.
□ I have not yet used the IRS DRT, but will use the tool to transfer 2018 IRS income information to the FAFSA.
□ I am unable or choose not to use the IRS DRT, and I will submit my 2018 IRS Tax Return Transcript.
2. If you answered NO, but worked in 2018, attach all copies of 2018 W-2 forms and complete the table listed
below:
Parent Income Source or Employer
(If none, indicate N/A)
2018 Amount Earned (If
none, indicate $0)
W-2 Provided? If no, please explain.
$
□
Yes
□
No ______________________________
$
□
Yes
□
No ______________________________
$
□
Yes
□
No ______________________________
E. Certifications 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. (
Signatures must be legible. Initials are not acceptable
as signatures.) WARNING: If you purposely provide false or misleading information on this worksheet, you may be fined, sentenced to jail, or
both.
Student Signature (Required) Date
Parent Signature (Required) Date
To submit the completed form: In person: Office of Financial Aid, Burgin-Dossett – Room 105; Mail: Office of Financial Aid, P.O. 70722, Johnson
City, TN 37614; Fax: (423) 439-5855
Accessibility Checked 7/8/2019
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2020 - 2021 Dependent Verification Worksheet (EDVW21) (East Tennessee State University)

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Completed 5 January 2021

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