Fillable 20202021 DEPENDENT STUDENT VERIFICATION WORKSHEET (Haskell Indian Nations University)

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20202021 DEPENDENT STUDENT VERIFICATION WORKSHEET (Haskell Indian Nations University)

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The 20202021 DEPENDENT STUDENT VERIFICATION WORKSHEET (Haskell Indian Nations University) form is 6 pages long and contains:

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  • 38 check-boxes
  • 87 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Haskell Indian Nations University

BROWSE HASKELL INDIAN NATIONS UNIVERSITY FORMS

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1 | P a g e 2 0 20 ‐ 2 0 2 1 D e p e n d e n t V e r i f i c a t i o n W o r k s h e e t
Haskell Indian Nations University Phone: (785) 749‐8468
Financial Aid Office Fax: (785) 832‐6617
155 Indian Avenue, Box 5027 Email: faoffice@haskell.edu
Lawrence, KS 66046
2020‐2021 DEPENDENT STUDENT VERIFICATION WORKSHEET
Your 2020‐2021 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law
states that before awarding federal student aid, we may need to confirm the information you reported on your FAFSA before
awarding Federal Student Aid using this worksheet and other required documents. If there are differences your FAFSA information
may need to be corrected. You and any parent whose information was reported on the FAFSA must complete and sign this
worksheet, attach any required documents, and submit them to the Financial Aid office. We may ask for additional information.
If you have questions about verification, contact us as soon as possible so that your financial aid will not be delayed.
V1 Standard
Complete Sections 1, 1A, 2, 3A, 3B and/or 3C, and 5 (Only)
V4 Custom
Complete Sections 1, 1A, 4, 5 and identify and statement of Education
Purpose. (Only)
V5 Aggregate
Complete Sections 1, 1A, 2, 3A, 3B and/or 3C, 4, 5, and identity and statement
of Educational Purpose. (All sections)
1. Student Information
Name:
Student ID Number:
Address:
Phone Number:
City, State Zip:
I plan on living: This needs to match your FAFSA status.
On campus Off campus
Off campus with parents
Email:
I plan on attending the following semesters:
Fall 2020 Spring 2021 Summer 2021
List ALL names of any other Colleges, Universities or
vocational/ technical schools that you have attended
previously.
1.
2.
3.
4.
Have you graduated with an AA/AS or BS/BA degree?
Yes
No Select either AA/AS or BS/BA
I release Financial Aid information and records to my Higher Education department, Haskell TRiO, Student
Success, AICF, parents or family members and other private scholarship sponsors as listed below:
I elect confidentiality and do not want any information released to anyone.
Name:
Relationship:
Phone Number:
Name:
Relationship:
Phone Number:
✔
2 | P a g e 2 0 20 ‐ 2 0 2 1 D e p e n d e n t V e r i f i c a t i o n W o r k s h e e t
2. Household Information
What is the marital status of the parent(s) whose information was reported on the FAFSA? If parent is
married to someone other than your other birth parent, the status should still be married.
Married/Remarried Divorced Separated Widowed
Unmarried and Both Parents (biological/adoptive) Living Together Never Married
Did the student’s parent (as listed on the FAFSA) RECEIVE child support in 2018?
Yes – List total the amount received in 2018 for all children $________________________
No
List the people in your parents’ household. Include:
• Yourself, even if you do not live with your parents.
• Yo
ur children, if they will receive more than half of their support from your parents from July 1, 2020 through June 30, 2020.
• Your parents. Do not include a parent who is not living in the household due to separation, divorce, or death.
• Your parents’ other children if they will receive more than half of their support from your parents from July 1, 2020
through June 30, 2021. Include graduate students, but not children for whom child support is paid or foster childre
n
s
upported by another entity
• Your unborn child and/or your parent’s unborn child, if that child will be born before June 30, 2021, and your parents
will provide
more than half of the child’s support from the projected date of birth through June 30, 2021.
• Other people, if they live with you and receive more than half of their support from your parents at the time of
application and will
continue to receive more than half of their support from July 1, 2020 through June 30, 2021.
• If you listed more than two individuals in college, we will need a class schedule of the other individual in college.
If dependents listed below will be enrolled at least half time in a degree, diploma or certificate program at a
p
ostsecondary educational institution anytime between July 1, 2020 and June 30, 2021, please complete
the information
in column four. If not, please leave column blank.
Full Name
Age
Relationship
College During 20‐21
Self
Haskell
Mother
NA
Father
NA
Dependent Student’s Family Information
Child Support ‐ Received
3 | P a g e 2 0 20 ‐ 2 0 2 1 D e p e n d e n t V e r i f i c a t i o n W o r k s h e e t
All tax filers must submit a copy of their 2018 IRS Tax Return Transcript or a signed copy of their tax return that was filed with the
IRS or other relevant tax authority unless they have transferred their 2018 income tax return information into the FAFSA using the
IRS Data Retrieval Tool (IRS DRT) in FAFSA on the Web or the myStudentAid app and have not subsequently changed that
information. Please submit copies of IRS Form 1040 Schedules 1, 2, and 3 if they were filed with the tax return. Please DO NOT
submit copies of any other IRS schedules (4, 5, 6, A, B, C, etc.), or state tax returns.
If either the student or a parent did not and will not file a 2018 federal tax return, that individual(s) should go to Section 3C.
3B. Verification of 2018 IRS Income Tax Return Information for Student and Parent Tax Filers
_____The student has not yet used the IRS DRT
but will use the tool to transfer 2018 IRS income
tax return information into the student’s FAFSA
once the 2018 IRS income tax return has been
filed.
_____The parent has not yet used the IRS DRT
but will use the tool to transfer 2018 IRS income
tax return information into the student’s FAFSA
once the 2018 IRS income tax return has been
filed.
Directions for using the IRS Data Retrieval Tool (IRS DRT) or requesting a Tax Return Transcript
*The IRS DRT is available in the financial information sections of the student’s FAFSA. Go to https://studentaid.ed.gov/sa/fafsa and
log in as a returning user. After you have logged in, choose the option for making corrections and locate the financial information
sections. You will have the option to use the IRS DRT as long as you (student) or your parent has “Already Completed” an IRS
income tax return. Once you use the IRS DRT for the student and/or parent, sign and submit the FAFSA. The FAFSA must be
signed electronically with the student’s and parent’s Federal Student Aid ID (FSA ID) and re-s
ubmitted for processing. If you have
any trouble with this process, feel free to call the Financial Aid Office for help.
** To obtain a
2018 IRS Tax Return Transcript, go to www.IRS.gov and click on “Get Your Tax Record.” Choose “Get Transcript
Online” or “Get Transcript by Mail.” Make sure to request the “Tax Return Transcript” and not the “Tax Account Transcript.” If unable
to use the online request processes, call 1-800-908-9946 or complete IRS Form 4506-T.
*** The tax filer can only use the IRS DRT or request a Tax Return
Transcript within 2 to 4 weeks after the tax return was filed
e
lectronically or within 6 to 8 weeks after a paper tax return was received by the IRS.
3C. Verification of 2018 Income Information for Nontax Filers
If the student or parent(s) were employed in 2018, they must list below the names of all employers, the amount earned from each
employer in 2018, and whether an IRS W
-2 form is provided. Provide copies of all 2018 W-2s issued to the student and parent(s) by
their employers. List every emp
loyer even if the employer did not issue a W-2. If more space is needed, provide a separate page with
the student’s name and ID number at the top. If a W
-2 is unavailable, attach a statement signed by the student and a parent explaining
why the W
-2 is unavailable and cannot be provided in a timely manner. Each parent who did not file a tax return also must submit a
Verification of Nonfiling Letter from the IRS
(or foreign taxing authority) dated on or after October 1, 2019. This letter may be
requested using “Get Transcript Online” on the IRS website at www.irs.gov or by completing IRS Form 4506-T.
Name of Student
Name of Parent
Employer’s Name
2018 Annual
Amount Earned
_____ The student has used the IRS DRT to transfer 2018 IRS income tax
return information into the student’s FAFSA.
_____The parent has used the IRS DRT to transfer 2018 IRS income tax
return information into the student’s FAFSA.
_____The student is unable or chooses not to use the IRS DRT, and instead
will provide the school
with a copy of his or her 2018 IRS Tax Return
Transcript or signed tax return with applicable schedules noted above.
_____The parent is unable or chooses not to use the IRS DRT, and instead
will provide the school with a copy of his or her 2018 IRS Tax Return
Transcript or signed tax return with applicable schedules noted above.
3A. Tax Forms and Income Information
4 | P a g e 2 0 20 ‐ 2 0 2 1 D e p e n d e n t V e r i f i c a t i o n W o r k s h e e t
Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2019 that indicates a
2018 IRS income tax return was not filed with the IRS or other relevant tax authority, or signed statement certifying
that the individual attempted to obtain confirmation of non-filing from the IRS or other relevant tax authority and was
unable to obtain the required documentation.
_____ Che
ck here if confirmation of non-filing or a signed statement is provided
_____ Check here if confirmation of non-filin
g or a signed statement will be provided later.
4. Student’s High School Completion Status (V4 and V5 only)
Provide one of the following documents indicating the student’s high school completion status when the
Student will begin college in 2020-2021. Check the box of the document you will attach to this worksheet.
_____ Office of Admissions has this documentation on file (no attachment necessary)
_____ High School Diploma
_____ Final official high school transcript including graduation date when diploma was awarded
_____ Copy of the “secondary school leaving certificate” (or other similar document) for students who
completed secondary education in a Foreign country and are unable to obtain a copy of their
high school diploma or transcript.
_____ General Education Development (GED) certificate or GED transcript
_____ State Certificate or test transcript received after the student has passed a state-authorized examination
the state recognizes as the equivalent of a high school diploma [e.g., High School Equivalency Test
(HiSet), Etc.]
_____ Academic Transcript of successfully completed two-year program acceptable for full credit toward a
Bachelor’s degree
_____ If state law requires a home schooled student to obtain a secondary school completion credential, a
transcript or the equivalent signed by your parent or guardian, that lists the secondary school courses
completed and documents the successful completion of a secondary school education in a home school
setting.
_____ DD Form 214, Certificate of Discharge from Active Duty, if it indicates student has a high school
diploma or its equivalent.
If you are unable to get any of the documents listed above, please contact our office at:
785-749-8468
5 | P a g e 2 0 20 ‐ 2 0 2 1 D e p e n d e n t V e r i f i c a t i o n W o r k s h e e t
Identity and Statement of Educational Purpose
(To be signed in person at the Institution)
The student must appear in person at Haskell Indian Nations University_ to
(Name of Postsecondary Educational Institution)
Verify their identity by presenting valid government‐issued photo identification (ID), such as, but not limited to, a driver’s license,
other state‐issued ID, or passport. The institution will maintain a copy of the student’s photo ID that is annotated with the date it
was received and reviewed and the name of the official at the institution authorized to collect the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose provided below.
Identify and Statement of Educational Purpose
(To be signed in the Presence of a Notary)
If the student is unable to appear in person at Haskell Indian Nations University
(Name of Postsecondary Educational Institution)
to verify their identity, the student must provide:
(a) A copy of the valid government‐issued photo identification (ID) that is acknowledged in the notary statement below, such as, but
not limited to a driver’s license, other state‐issued ID, or passport; and
(b) The original Statement of Educational Purpose, which is provided below, must be notarized. If the notary statement appears on
a separate page than the Statement of Educational Purpose, there must be a clear indication that the Statement of Educational
Purpose was the document notarized.
Statement of Educational Purpose
I certify that I am the individual signing
(Print Student’s Name)
this Statement of Educational Purpose and that the Federal student financial assistance I may receive will only be used for
educational purposes and to pay the cost of attending Haskell Indian Nations University for 2020‐2021.
(Name of Postsecondary Educational Institution)
Identity and Statement of Educational Purpose
(V4 and V5 Only)
6 | P a g e 2 0 20 ‐ 2 0 2 1 D e p e n d e n t V e r i f i c a t i o n W o r k s h e e t
Notary’s Certificate of Acknowledgement (V4 and V5 only)
State of
City/County of
On , before me,
Date (Notary’s name)
Personally appeared,
(Printed name of signer)
on basis of satisfactory evidence of identification
(Type of government‐issued photo ID provided)
to be the above‐named person who signed the foregoing instrument.
WITNESS my hand and official seal
(Seal) (Notary signature)
My commission expires on
By signing this form, I certify that I have reviewed all of the information and that the information reported on this form is true and
correct to the best of my ability. I also understand that if I purposefully give false or misleading information, I am violating a Federal
Statute and could face monetary penalties and sentenced to jail.
Print Student’s Name Student’s ID Number
Student’s Signature Date
Parent’s Signature Date
5. Certification and Signature
WARNING: If you purposely give false or misleading information you may be fined, be sentenced to jail, or both.
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20202021 DEPENDENT STUDENT VERIFICATION WORKSHEET (Haskell Indian Nations University)

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Completed 1 February 2021

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