Instructions: fill out form, choose ‘print’ icon then ‘save as pdf’ and email form from your device to financialaid@rpcc.edu
2020-2021 INDEPENDENT HOUSEHOLD WORKSHEET (V1)
Student’s Name: _________________________________________ Student ID #: _____________________________________
Mailing Address: _____________________________________________ Phone Number: _________________________________
Email Address: ______________________________________________________________________________________________
SECTION 1-A: NUMBER OF HOUSEHOLD MEMBERS
Number of Household Members: List below the people considered in the student’s household for FAFSA purposes, including:
The student.
The student’s spouse, if the student is married.
The student’s or spouse’s children if the student and/or spouse will provide more than half of the children’s support from
July 1, 2020 through June 30, 2021.
Other people if they now live with the student and the student or spouse provides more than half of the other person’s
support, and will continue to provide more than half of that person’s support through June 30, 2021.
SECTION 1-B: NUMBER OF HOUSEHOLD MEMBERS IN COLLEGE
Number in College: Of the household members defined above, include in the table information about any household member who is,
or will be, enrolled 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, and include the full name of the college.
TABLE 1: NUMBER OF HOUSEHOLD MEMBERS AND COLLEGE
Include household members who are not in college but meet the criteria in Section 1-A. If more space is needed, provide a
separate page with the student’s name at the top.
Full Name
Age
Relationship to
Student
Full Name of College
At Least Half Time?
self
[ ] yes [ ] no
[ ] yes [ ] no
[ ] yes [ ] no
[ ] yes [ ] no
[ ] yes [ ] no
[ ] yes [ ] no
Note: We may require additional documentation if we have reason to believe that the information regarding the household
members enrolled in eligible postsecondary educational institutions is inaccurate.
Office of Financial Aid & Scholarships
Gonzales-Westside-Reserve Campuses
Financialaid@rpcc.edu
SECTION 2: STUDENT (AND SPOUSE, IF APPLICABLE) TAX FILING STATUS
Check the box that applies (Only check one (1) box):
The student (and spouse if applicable) has used the IRS DRT in FAFSA on the Web to transfer 2018 IRS income tax return information
into the student’s FAFSA.
The student (and spouse if applicable) has not yet used the IRS DRT in FAFSA on the Web, but will use the tool to transfer 2018 IRS
income tax return information into the student’s FAFSA.
The student (and spouse if applicable) is unable or chooses not to use the IRS DRT in FAFSA on the Web, and instead will provide the
school with a 2018 IRS Tax Return Transcript(s).*
******IMPORTANT: Only complete the following section if you DID NOT file a tax return for 2018 and have wages to report******
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
IRS W-2 Attached? Yes or No
A 2018 IRS Tax Return Transcript may be obtained through:
Get Transcript by MAIL Go to www.irs.gov, under the Tools heading, click "Get a tax transcript.” Click “Get Transcript by MAIL.” Make sure to request the “IRS Tax
Return Transcript” and NOT the “IRS Tax Account Transcript.” The transcript is generally received within 10 business days from the IRS’s receipt of the online request.
Get Transcript ONLINE Go to www.irs.gov, under the Tools heading, click "Get a tax transcript." Click “Get Transcript ONLINE.” Make sure to request the “IRS Tax
Return Transcript” and NOT the “IRS Tax Account Transcript.” To use the Get Transcript Online tool, the user must have (1) access to a valid email address, (2) a text-
enabled mobile phone (pay-as-you-go plans cannot be used) in the user’s name, and (3) specific financial account numbers (such as a credit card number or an
account number for a home mortgage or auto loan). The transcript displays online upon successful completion of the IRS’s two-step authentication. Automated
Telephone Request 1-800-908-9946. Transcript is generally received within 10 business days from the IRS’s receipt of the telephone request. Paper Request Form
IRS Form 4506T-EZ or IRS Form 4506-T. The transcript is generally received within 10 business days from the IRS’s receipt of the paper request
SECTION 3: CERTIFICATION AND SIGNATURES
Each person signing this worksheet certifies that all of the information reported on it and on accompanying documents are complete and correct.
If you purposely provide false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
The student (and spouse) must sign and date:
_________________________________________________ _________________________________
Student’s Signature Date
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