Fillable 20202021 DEPENDENT VERIFICATION WORKSHEET (Ancilla College)

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20202021 DEPENDENT VERIFICATION WORKSHEET (Ancilla College)

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2020-2021 Dependent Verification Worksheet Page | 1
2020–2021 DEPENDENT VERIFICATION WORKSHEET
Your 2020–2021 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 the financial aid administrator at your school 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 financial aid administrator at your school. Your
school may ask for additional information. If you have questions about verification, contact your financial aid administrator as soon as possible so that
your financial aid will not be delayed.
A. Dependent Student’s Information
Student’s School ID Number
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 below the people in your parent(s)’ household. Include:
Yourself
Your parent(s) (including a stepparent) even if you don’t live with the parent(s).
Your parent(s)’ other children if the parent(s) will provide more than half of their support from July 1, 2020 through June 30,
2021, or if the other children would be required to provide parental information if they were completing a FAFSA for 2020–
2021. Include children who meet either of these standards, even if they do not live with the parent(s).
Other people if they now live with the parent(s) and the parent(s) provide more than half of their support and will continue to
provide more than half of their support through June 30, 2021.
Include the name of the college for any household member, excluding your parent(s), who will be enrolled, at least half time in a
degree, diploma, or certificate program at a postsecondary educational institution any time between July 1, 2020, and June 30,
2021. If more space is needed, attach a separate page with the student’s name and Social Security Number at the top.
Full Name
Ag
Relation
ship
College
Will be Enrolled at
Least Half Time
Missy Jones (example)
18
Sister
Central University
Yes/No
Self
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.
Student’s Last Name
Student’s First Name
Student’s M.I.
Student’s Street Address (include apt. no.)
Student Name: __________________________________ SSN: __________________________
2020-2021 Dependent Verification Worksheet Page | 2
C. Dependent Student’s Income Information to Be Verified
1. TAX RETURN FILERS—Important Note: If the student filed, or will file, an amended 2018 IRS tax return, the student must
contact the financial aid administrator before completing this section.
Instructions: Complete this section if the student filed or will file a 2018 IRS income tax return. The best way to verify income is
by using the IRS Data Retrieval Tool (IRS DRT) that is part of FAFSA on the Web at FAFSA.gov. In most cases, no further
documentation is needed to verify 2018 income information that was transferred into the student’s FAFSA using the IRS DRT if
that information was not changed by the FAFSA filer. If you need more information about when, or how to use the IRS Data
Retrieval Tool see your financial aid administrator.
Check the box that applies:
The student 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 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 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).
A 2018 IRS Tax Return Transcript may be obtained through:
• Get Transcript by MAIL – Go to www.irs.gov, u
nder 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 form.
2. DEPENDENT STUDENTS WITH UNUSUAL IRS CIRCUMSTANCES—complete this section if the student has filed, or
will file a 2018 income tax return with any of the following circumstances.
Check the box that applies:
The student is required to file a 2018 IRS income tax return and has been granted a filing extension by the IRS, must
provide.
A copy of IRS Form 4868, ‘‘Application for Automatic Extension of Time to File U.S. Individual Income Tax
Return,’’ that was filed with the IRS for tax year 2018;
A copy of the IRS's approval of an extension beyond the automatic six-month extension if the individual requested
an additional extension of the filing time for tax year 2018;
Student Name: __________________________________ SSN: __________________________
2020-2021 Dependent Verification Worksheet Page | 3
Verification of Non-Filing Letter (confirmation that the tax return has not yet been filed)
from the IRS or other relevant tax authority dated on or after October 1, 2019;
A copy of IRS Form W–2 for each source of employment income received for tax year 2018 and,
If self-employed, a signed statement certifying the amount of the individual’s Adjusted Gross Income (AGI) and the
U.S. income tax paid for tax year 2018.
The student was the victim of IRS tax-related identity theft, must provide:
A Tax Return Database View (TRDBV) transcript obtained from the IRS, or any other IRS tax transcript(s) that
includes all of the income and tax information required to be verified; and
A statement signed and dated by the tax filer indicating that he or she was a victim of IRS tax-related identity theft
and that the IRS is aware of the tax-related identity theft.
3. TAX RETURN NONFILERS—Complete this section if the student, will not file and is not required to file a 2018 income tax
return with the IRS.
Check the box that applies:
The student was not employed and had no income earned from work in 2018.
The student was employed in 2018 and has listed below the names of all the student’s employers, the amount earned from
each employer in 2018, and whether an IRS W-2 form is provided. Copies of all 2018 IRS W-2 forms issued to the student
by employers must be provided. List every employer even if they did not issue an IRS W-2 form. If more space is needed, attach a
separate page with the student’s name and Social Security Number at the top.
Employer’s Name
2018 Amount Earned
IRS W-2 Provided?
Suzy’s Auto Body Shop (example)
$2,000.00(example)
Yes(example)
Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2018 that indicates a
20167 IRS income tax return was not filed with the IRS or other relevant tax authority.7
Check here if confirmation of non-filing is provided.
Check here if confirmation of non-filing will be provided later.
D. Parent’s Income Information to Be Verified—Note: If two parents were reported in Section B of this worksheet, the instructions
and certifications below refer and apply to both parents.
1. TAX RETURN FILERS—Important Note: Notify the financial aid office if the parents filed separate IRS income tax returns for
2018 or had a change in marital status after December 31, 2018.
Instructions: Complete this section if the student’s parent(s) filed or will file a 2018 income tax return with the IRS. The best
way to verify income is by using the IRS Data Retrieval Tool that is part of FAFSA on the Web Web at www.FAFSA.gov. In most
cases, no further documentation is needed to verify 2018 income information that was transferred into the student’s FAFSA
using the IRS DRT if that information was not changed by the FAFSA filer. If you need more information about whether or how
to use the IRS Data Retrieval Tool see the student’s financial aid administrator.
Student Name: __________________________________ SSN: __________________________
2020-2021 Dependent Verification Worksheet Page | 4
Check the box that applies:
The parent has used the IRS Data Retrieval Tool in FAFSA on the Web to transfer 2018 IRS income information into the
student’s FAFSA. The student’s school will use the IRS information transferred into the student’s FAFSA to complete the
verification process.
The parent has not yet used the IRS Data Retrieval Tool, but will use the tool to transfer 2018 IRS income information into
the student’s FAFSA once the parent’s IRS tax return has been filed.
The parent is unable or chooses not to use the IRS Data Retrieval Tool, and the parent will provide the school a copy of the
2018 IRS tax return transcript(s)—not photocopies of the income tax return.
To obtain an IRS tax return transcript go to www.IRS.gov and click “Get a Transcript” link under the Tools heading, or
call 1-800-908-9946. Make sure you order the “IRS tax return transcript” and not the “IRS tax account transcript.” It
takes up to two weeks for IRS income information to be available for electronic IRS tax return filers, and up to eight
weeks for paper tax return filers. If the parents are married, and separate 2018 tax returns were filed, 2018 IRS tax
return transcripts must be submitted for each parent.
Check here if 2018 IRS tax return transcript(s) is provided.
Check here if 2018 IRS tax return transcript(s) will be submitted to the student’s school later. Verification cannot be
completed until the IRS tax return transcript(s) has been submitted to the school.
2. PARENTS WITH UNUSUAL IRS CIRCUMSTANCES—Complete this section if the student’s parent(s) has filed, or will file
a 2018 income tax return with any of the following circumstances.
Check the box that applies:
The parent is required to file a 2018 IRS income tax return and has been granted a filing extension by the IRS, must
provide.
A copy of IRS Form 4868, ‘‘Application for Automatic Extension of Time to File U.S. Individual Income Tax
Return,’’ that was filed with the IRS for tax year 2018;
A copy of the IRS's approval of an extension beyond the automatic six-month extension if the individual requested
an additional extension of the filing time for tax year 2018;
Verification of Non-Filing Letter (confirmation that the tax return has not yet been filed) from the IRS or other
relevant tax authority dated on or after October 1, 2018;
A copy of IRS Form W–2 for each source of employment income received for tax year 2018 and,
If self-employed, a signed statement certifying the amount of the individual’s Adjusted Gross Income (AGI) and the
U.S. income tax paid for tax year 2018.
The parent has filed an amended IRS income tax return for tax year 2018, must provide:
A 2018 IRS Tax Return Transcript (that will only include information from the original tax return and does not have
to be signed), or any other IRS tax transcript(s) that includes all of the income and tax information required to be
verified; and
A signed copy of the 2018 IRS Form 1040X, “Amended U.S. Individual Income Tax Return,” that was filed with
the IRS.
The parent was the victim of IRS tax-related identity theft, must provide:
Student Name: __________________________________ SSN: __________________________
2020-2021 Dependent Verification Worksheet Page | 5
A Tax Return Database View (TRDBV) transcript obtained from the IRS, or any other IRS
tax transcript(s) that includes all of the income and tax information required to be verified; and
A statement signed and dated by the tax filer indicating that he or she was a victim of IRS tax-related identity theft
and that the IRS is aware of the tax-related identity theft.
3. TAX RETURN NONFILERS—Complete this section if the student’s parent(s) will not file and not required to file a 2018
income tax return with the IRS.
Check the box that applies:
The parent(s) was not employed and had no income earned from work in 2018.
The parent(s) was employed in 2018 and has listed below the names of all the parent’s employers, the amount earned from
each employer in 2018, and whether an IRS W-2 form is provided. Copies of all 2018 IRS W-2 forms issued to the parent(s) by
employer(s) must be provided. List every employer even if they did not issue an IRS W-2 form. If more space is needed, attach a
separate page with the student’s name and Social Security Number at the top.
Employer’s Name
2018 Amount Earned
IRS W-2 Provided?
Suzy’s Auto Body Shop (example)
$2,000.00 (example)
Yes (example)
Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2018 that indicates a 2018
IRS income tax return was not filed with the IRS or other relevant tax authority.
Check here if confirmation of non-filing is provided.
Check here if confirmation of non-filing will be provided later
E. High School Completion Status
Provide one of the following documents that indicate your high school completion status when the student begins college in 2019–
2020:
A copy of the student’s high school diploma showing when graduated.
For students who completed secondary education in a foreign country, a copy of the “secondary school leaving certificate” or
other similar document.
A copy of the student’s final official high school transcript that shows the date when the diploma was awarded.
A state certificate or transcript received by a student after the student passed a State-authorized examination that the State
recognizes as the equivalent of a high school diploma (GED test, HiSET, TASC, or other State-authorized examination).
An academic transcript that indicates the student successfully completed at least a two-year program that is acceptable for full
credit toward a bachelor’s degree.
For a student who was homeschooled in a state where state law requires the student to obtain a secondary school completion
credential for homeschooling (other than a high school diploma or its recognized equivalent), a copy of that credential.
For a student who was homeschooled in a state where state law does not require the student to obtain a secondary school
completion credential for homeschooling (other than a high school diploma or its recognized equivalent), a transcript, or the
equivalent, signed by the student's parent or guardian, that lists the secondary school courses the student completed and includes a
statement that the student successfully completed a secondary school education in a homeschool setting.
Student Name: __________________________________ SSN: __________________________
2020-2021 Dependent Verification Worksheet Page | 6
Check the box that applies:
The student has submitted a final official transcript or equivalent to the Admissions Office. The financial aid administrator
will use this information for the verification process.
The student has not yet submitted a final official transcript or equivalent. The student’s admissions file or the verification
process cannot be completed until a final official transcript or equivalent has been received.
A student who is unable to obtain the documentation listed above must contact the financial aid office. If we have already
received one of the documents above as part of the admission process, you do not need to turn in another copy.
F. Identity and Statement of Educational Purpose
To be signed at the Institution:
The student must appear in person at to verify his or her identity
(Name of Postsecondary Educational Institution)
by presenting an unexpired 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 by the institution with the
date it was received and reviewed, and the name of the official at the institution authorized to receive and review the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose provided below.
To be signed in the presence of a Notary:
If the student is unable to appear in person at the Institution to verify his or her identity, the student must provide to the Institution:
A A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged in the notary statement below, or
that is presented to a notary, such as, but not limited to, a driver’s license, other state-issued ID, or passport; and
B The original Statement of Educational Purpose provided below, which 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 this Statement of Educational Purpose
(Print Student’s Name)
and that the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of
attending for 2018-2019.
(Name of Postsecondary Educational Institution)
Student’s Signature Date Student’s ID Number
Authorized Institutional Official’s Signature Date
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Student Name: __________________________________ SSN: __________________________
2020-2021 Dependent Verification Worksheet Page | 7
Notary’s Certificate of Acknowledgement
State of City/County of
On before me, personally appeared,
(Date) (Notary’s Printed Name)
, and provided to me on basis of satisfactory evidence of identification
(Printed Name of Signer)
to be the above-named person who signed the foregoing instrument.
(Type of government-issued photo ID provided)
WITNESS my hand and official seal:
(Notary signature) (Seal) (Date)
G. Certification and Signatures
Each person signing this worksheet certifies that all of the
information reported on it is complete and correct. The
student and one parent whose information was reported on
the FAFSA must sign and date.
Student’s Signature Date
Parent’s Signature Date
Do not mail this worksheet to the U.S. Department of Education.
Submit this worksheet to the financial aid administrator at your school.
You should make a copy of this worksheet for your records.
WARNING: If you purposely give false or misleading
information on this worksheet, you may be fined, be sentenced
to jail, or both.
My commission expires on
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Completed 25 July 2020

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