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

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20202021 INDEPENDENT STUDENT VERIFICATION WORKSHEET (Haskell Indian Nations University)

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

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  • 34 check-boxes
  • 99 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 Independent 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 INDEPENDENT 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.
Have you graduated with your AA/AS or BA/BS degree? Yes
No Select either AA/AS or BA/
BS
1A. Financial Aid Release of Information
I release Financial Aid information and records to my Higher Education department, Haskell TRIO, Student
Success, and AICF. In addition to that, I release information to the individuals listed below.
I elect confidentiality and do not want any information released to anyone.
Tribe Name:
Name:
Higher Education Department
Relationship:
Phone Number:
Phone Number:
Name:
Name:
Relationship:
Relationship:
Phone Number:
Phone Number:
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.
✔
2 | P a g e 2 0 20 ‐ 2 0 2 1 Independent 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 your current marital status?
_____ Married _____Never Married _____ Divorced _____ Separated _____ Widowed
If applicable, list the month and year you were married, divorced, separated or widowed:
_________________
Did the student’s (as listed on the FAFSA) RECEIVE child support in 2018?
Yes – List total the amount received in 2018 for all children $________________________
No
• Yourself, the student.
• The student’s spouse, if the student is married.
• Your dependent children if they will receive more than half of their support from you from July 1, 2020 through
June 30, 2021, even if a child does not live with the student. Do not include children for whom child support is
paid or foster children supported by another entity.
• Your unborn child, if that child will be born before June 30, 2021, and you 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 you provide more than half of their support and will
continue to
provide 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
po
stsecondary 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
Child Support ‐ Received
3 | P a g e 2 0 20 ‐ 2 0 2 1 Independent V e r i f i c a t i o n W o r k s h e e t
3A. Tax Forms and Income Information
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
spouse 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 Tax Filers
The student and spouse has used the IRS DRT in
FAFSA on the Web to transfer 2018 Income Tax return
information into the FAFSA application
The student and spouse is unable to use the IRS DRT
in
FAFSA on the Web, and instead will provide the school
a
2018 IRS Tax Return Transcript. (1‐800‐908‐9946)
The student or parent is has submitted a signed and dated copy of their 2018 tax form and applicable schedules.
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 section 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
section. You will have the option to use the IRS DRT as long as you (student) or your spouse has “Already Completed” an IRS
income tax return. Once you use the IRS DRT for the student and/or spouse, sign and submit the FAFSA. The FAFSA must
be
signed electronically with the student’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 processe
s, 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 fi
led
electronically 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 spouse was employed in 2018, he or she must list below the names of all employers, the amount earned from each
employer in 2018, and whether an IRS W
-2 form was provided. Provide copies of all 2018 W-2s issued to the student and spouse
by their employers. List every employer 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 explaining why
the W
-2 is unavailable and cannot be provided in a timely manner. The student and/or spouse who did not file a tax return also
must submit a Verification of Non
-filing Letter from the IRS (or relevant 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
4 | P a g e 2 0 20 ‐ 2 0 2 1 Independent 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 Independent 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 Independent 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
Spouse Signature Optional 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 INDEPENDENT STUDENT VERIFICATION WORKSHEET (Haskell Indian Nations University)

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Completed 1 February 2021

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