2020-2021 Dependent Verification Worksheet
Federal Student Aid Programs
Your 20202021 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 and your parents reported on your FAFSA. To verify that you provided correct information, we 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 and at least one parent must complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the Office of
Student Financial Services. The office may ask for additional information. If you have questions about verification, contact the Office of Student Financial Services as soon
as possible so that your financial aid will not be delayed.
A. Dependent Student’s Information (please print): (Sections A D must be completed)
__________________________________ _________________/____________
Student’s Last Name Student’s First Name Student’s M.I. Student’s Social Security Number AND Student 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. Dependent Student’s Family Information
List the people in your parent(s) household including:
Yourself and your parent(s), including step-parents, even if you do not live with your parents, and
Your parents’ other children, even if they don’t live with your parents(s), if (a) your parent will provided 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, and
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, 2021.
Write your name on the first line, and then names of all household members in the spaces below. Then, write in the name of the college for any household
member who will be attending at least half time in a degree, diploma, or certificate program at an eligible postsecondary educational institution any time
between July 1, 2020 and June 30, 2021. Do NOT include college information for parents. If you need more space, attach a separate page.
SNAP BENEFITS RECEIVED I certify that a member of my household, listed in Section B of this worksheet, received SNAP benefits in 2018 or 2019. If
requested, I will provide documentation of the receipt of SNAP benefits during 2018 and/or 2019.
CHILD SUPPORT PAID I certify that one or both of the students parents paid child support in 2018. I understand that I may be requested to provide
additional documentation of the payment of child support. Do not include child support received in this section. Fill out the table below. If you need more space,
attach a separate page.
Name of Person
Who Paid Support
Name of Person to Whom Child Support
Was Paid to
Name of Child for Whom Support Was
Paid for
Age of
Total Amount of Child
Support Paid in 2018
Will be Enrolled at
Least Half Time?
Version: 02/10/2020
C. Tax Forms and Income Information
Check one
Check one
I have used the IRS Data Retrieval Tool to retrieve and transfer my 2018 IRS income information into the student’s FAFSA. Proceed to Untaxed Income below.
I have not used the IRS Data Retrieval Tool when filing the FAFSA on the web. I have attached my 2018 U.S. Tax Return Transcript to this worksheet.
Please note that a tax return transcript is not the same as your original 1040 tax filing. To request a Tax Return Transcript, online or by mail, from the Internal
Revenue Service go online to www.IRS.gov. Make sure to request the “IRS Tax Return Transcript”, not the “Tax Account Transcript”. Transcripts can be ordered
via their Automated Telephone Request service at 1-800-908-9946. If using the Paper Request Form 4506T-EZ or 4506-T, first, send the transcript to your own
address, and then turn in a copy with your verification form. Verification cannot be completed until all transcripts are in. Proceed to Untaxed Income below.
IF YOU DID NOT FILE TAXES - a non-filers statement from the IRS is required
Check here if you and/or your parents worked, but did not file, and were not required to file, a 2018 Federal income tax return. Then list the names of all employers
and any income received in 2018 below. Copies of your W-2(s) are required. Proceed to both Untaxed Income and Section D below.
Student’s Employer(s)
Parent’s Employer(s)
Check here if either you or your parents were not employed and had no income earned from work in 2018.
A non-filers statement from the IRS is required. Proceed to both Untaxed Income and Section D below.
Payments to tax-deferred pension and savings plans (paid directly or withheld from earnings), including, but not limited to, amounts reported on the W-2 forms
in Boxes 12a through 12d, codes D, E, F, G, H, and S. Dont include amounts reported in code DD *** Attach W2(s)***
IRA deductions and payments to self-employed SEP, SIMPLE, Keogh, and other qualified plans from IRS Form 1040 Schedule 1 - total of lines 28 + 32
Child Support received for all children in your household in 2018. Do not include foster care, adoption payments, or any amount that was court-ordered but not
actually paid. You may be requested to supply documentation.
Tax Exempt interest income from IRS Form 1040 (line 2a).
Untaxed portions of IRA distributions and pensions from IRS Form 1040 (line 4a minus line 4b). Exclude Rollovers. If negative, enter a zero here.
Housing, food, and other living allowance paid to members of the military, clergy, and others (including cash payments and cash value of benefits). Dont
include the value of on-base military housing or the value of a basic military allowance for housing.
Veteran’s non-education benefits such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC) and/or VA Educational Work-Study
Other untaxed income or benefits not reported elsewhere, such as workers compensation, disability benefits, untaxed foreign income, etc. Also include the
untaxed portions of health savings accounts from IRS Form 1040 Schedule 1- line 25. Don’t include foster care benefits, student aid, earned income credit,
additional child tax credit, welfare payments, untaxed Social Security benefits, SSI, WIA educational benefits, on-base military housing or a military housing
allowance, combat pay, or benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion or credit for federal tax on special fuels.
Money received or paid on your behalf (for bills in your name) not reported elsewhere on this form. Include 529 plan that is owned by someone other than your
parents (such as grandparent, aunt, or uncle.)
D. Household Resources/Documentation of Support (If you reported low or no earned income, this section must be completed. Please attach explanation.)
So that we can fully understand a student’s family financial situation, please provide information about any other resources, benefits, and other amounts received by the student and any
members of the student’s household on a separate sheet or attach documentation. Include support received that was not required to be reported on the FAFSA or other forms submitted to
the financial aid office. This should include Social Security benefits, financial aid refunds, Federal Work/Study, etc.
E. Sign this Worksheet
Student Date
Parent Date
Please note that processing may take 3 4 weeks after documents are received especially during peak processing.
OR return to Financial Aid office located at either campus: MAIL THIS FORM TO ADDRESS BELOW…
Calhoun Community College
Office of Financial Aid
P.O. Box 2216
Decatur, AL 35609
Decatur Campus
6250 Hwy 31 North
Tanner, AL 35671
Huntsville/Research Park Campus
102-B Wynn Drive
Huntsville, AL 35805
WARNING: If you purposely give false or misleading information on this
worksheet, you may be fined, be sentenced to jail, or both.
By signing this worksheet you are certifying that all the information reported, to qualify for Federal student aid, is complete and correct. Please sign and date the worksheet below.
I have agreed to submit this application by electronic means. By signing this application
electronically, I certify under penalty of perjury and false swearing that my answers are correct
and complete to the best of my knowledge.
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.