2020-2021
Certification of Non-Tax Filing
I, ___________________________
______, by signing below, am certifying the following:
• I did not file taxes for 2018.
• I was not required by law to file a 2018 tax return with the Internal Revenue Service (IRS).
• If I earned income, all income sources and amounts are listed on this form.
• I have provided all corresponding 2018 W-2 statements, IRS Wage and Income Statement, or if self employed,
signed statement with AGI and taxes paid to the college.
• I attempted to obtain Verification of Nonfiling from the IRS (or foreign tax authority
if applicable) but was unable to obtain the required documentation.
Sources of EARNED Income for 2018:
Name of Employer_________________________________ Gross Amount Earned: ____________
Name of Employer_________________________________ Gross Amount Earned: ____________
Name of Employer_________________________________ Gross Amount Earned: ____________
Name of Employer_________________________________ Gross Amount Earned: ____________
Name of Employer_________________________________ Gross Amount Earned: ____________
**If you have additional employers/amounts earned, please submit them on a separate sheet of paper.
I certify that I understand that the Secretary of Education has the authority to verify information reported on my
application (or my child’s or my spouse’s application) with the Internal Revenue Service and other federal agencies. If
I purposely give false or misleading information, I may be fined, imprisoned, or both.
Signature: _________________________________ Date: ____________
Student Name: _____________________________
I was not employed and had no income from work in 2018.
I earned income in 2018 (attach W2 for each job listed or IRS Wage & Income Transcript).
Check the applicable box:
Student ID: ______________________
