Financial Aid
2020-2021 Verification Worksheet
V1 – Standard Group
Your 2020-2021 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called
verification. Clark State Community College is required to collect the following information and compare it to the
information reported on the FAFSA. If any discrepancies are found, we will make the corrections to your FAFSA. No
federal financial aid will be oered until all discrepancies have been resolved and the FAFSA has been corrected.
SECTION A: Student Information
Name__________________________________________ Student ID Number_____________________________
Address_________________________________ _____________________________ ____________ ____________
Street City State Zip
Home Phone_________________________ Work Phone ______________________________________
SECTION B: Family Information
If more space is needed, attach a separate page with the student’s name and student ID at the top.
Financial Aid
FAC20VG1
Dependent Students
List the people in your Parent’s household including:
Independent Students
List the people in your household including:
Yourself and your parent(s), including step-parent Yourself, and your spouse, if you have one
Your parents’ other children, IF your parents will provide more
than half of their support from July 1, 2020 thru June 30,
2021 OR the children would be required to provide parental
information when filing the FASFA.
Your children, if you will provide more than half of their
support from July 1, 2020 through June 30, 2021
Other people if they now live with your parents and your parents
provide more than half of their support and will continue to from
July 1, 2020 through June 30, 2021
Other people if they now live with you and you provide
more than half of their support and will continue to from
July 1, 2020 through June 30, 2021
Full Name Age
Relationship to
Student
College
Will be Enrolled at
least HALF TIME
(Yes or No)
Self Clark State
SECTION C: Tax Forms and Income Information (all applicants)
STUDENT Tax Forms and Income Information
Check only one box below
The STUDENT has used the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer 2018 IRS
income information into the student’s FAFSA.
The STUDENT is unable or chooses not to use the IRS Data Retrieval Tool in FAFSA on the Web, and will
instead provide the school with a 2018 IRS Tax RETURN Transcript(s) or a signed copy of 2018 federal
income tax return and applicable schedule. Tax RETURN transcripts can be requested from the IRS by
calling (800)908-9946 or by using this link: www.irs.gov/Individuals/Get-Transcript.
Check here if you did not and were not required to file a federal income tax return and attempted to obtain
the IRS Verification of Nonfiling letter but were unable to obtain the letter.
Financial Aid
937.328.6034 | financialaid@clarkstate.edu | 570 East Leel Lane, Springfield, Ohio 45505
SPOUSE’S or PARENT’S Tax Forms and Income Information
Check only one box below
The SPOUSE/PARENT has used the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer
2018 IRS income information into the student’s FAFSA.
The SPOUSE/PARENT is unable or chooses not to use the IRS Data Retrieval Tool in FAFSA on the Web,
and will instead provide the school with a 2018 IRS Tax RETURN Transcript(s) or a signed copy of 2018
federal income tax return and applicable schedule. Tax RETURN transcripts can be requested from the IRS
by calling (800)908-9946 or by using this link:
www.irs.gov/Individuals/Get-Transcript.
Check here if you did not and were not required to file a federal income tax return and attempted to obtain
the IRS Verification of Nonfiling letter but were unable to obtain the letter.
Sources of Income
Complete only if you did not file taxes
Amount Earned in 2018 W-2 Attached
$
$
$
If you did not file and were not required to file a 2018 Federal income tax return, list below all employer(s) and
any income received in 2018 (use W-2 or other earning statements if available)
SECTION E: Certification Statement
I certify that all of the information on this form and accompanying documents are true and complete to the
best of my knowledge. Furthermore, I arm that I have not knowingly or intentionally provided any false or
fraudulent documentation.
Student Signature _________________________________________________________Date_________________
Parent Signature (if parent information is provided) _____________________________Date_________________
If you (SPOUSE/PARENT) did not file and were not required to file a 2018 Federal income tax return, list below
all employer(s) and any income received in 2018 (use W-2 or other earning statements if available)
Sources of Income
Complete only if you did not file taxes
Amount Earned in 2018 W-2 Attached
$
$
$
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