Fillable 2021-2022 Dependent V5 Aggregate Verification Worksheet (Louisiana College)

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2021-2022 Dependent V5 Aggregate Verification Worksheet (Louisiana College)

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2021-2022 Dependent
V5 Aggregate Verification Worksheet
Page1
Your FAFSA application has been selected for a process called verification. Please complete all parts of this worksheet and return to the Financial Aid
Office. Notice: incomplete forms may delay processing.
B. Household Information – List the members in your parents’ household. Attach an additional sheet if necessary.
Please include: yourself, even if you don’t live with your parents, your parents/step-parent (if your parent is remarried you must include your step-
parent), your parents’ other children (even if they do not live with your parents), siblings, and individuals who will receive more than half of their
support from your parents between July 1, 2021 and June 30, 2021.
Full Name
Relationship to
Student
Age
Enrolled in College
at least half-time
(check one)
College
Self
☐ Yes
Louisiana College
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ Yes
C. Tell us about your 2019 tax filing status –
Student’s Filing Status (select only one)
• I filed my 2019 return and successfully used the IRS Data
Retrieval Tool via the FAFSA. Tax transcript not required.
• I filed my 2019 return and chose not to or, I am unable to use
the IRS Data Retrieval Tool. Submit your 2019 IRS Tax
Return Transcript or Return.
• I amended my taxes after originally filing my 2019 return and
will submit:
o 2019 IRS Tax Return Transcript
o 2019 Signed IRS 1040X form
• I did not and I am not required to file a federal tax return. I
was not employed and earned no income from work in 2019
Submit 2019 IRS Verification of Non-filing Letter*
• I did not and I am not required to file a federal tax return. In
2019 I earned $________ from the source(s) listed below:
Submit 2019 IRS Verification of Non-filing Letter*
Employer’s Name
2019 Earned
Amount
IRS W-2 Attached
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Attach all W-2s issued to you in 2019
*IRS Verification of Non-Filing Letters can be requested by checking box 7 and
8 (if no W-2s provided) on IRS Form 4506-T. Notice: 2019 IRS Verification of
Non-Filing Letters must be dated on or after October 1, 2019.
Parent(s) Filing Status (select only one)
• My parent(s) filed their 2019 return and successfully used
the IRS Data Retrieval Tool via the FAFSA. Tax transcript
not required.
• My parent(s) filed their 2019 tax return and chose not to or,
were not able to use the IRS Data Retrieval Tool. Submit
parent’s 2019 IRS Tax Return Transcript or Return.
• My parent(s) amended their taxes after originally filing their
return and will submit:
o 2019 IRS Tax Return Transcript
o 2019 Signed IRS 1040X form
•
•
My parent(s) did not and is/are not required to file a federal
tax return. My parent(s) were not employed and earned no
income from work in 2019 Submit 2019 IRS Verification of
Non-filing Letter*
My parent(s) did not and is/are not required to file a federal
tax return. In 2019 my parent(s) earned $________ from
the source(s) listed below: Submit 2019 IRS Verification of Non-
filing Letter*
Employer’s Name
2019 Earned
Amount
IRS W-2 Attached
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Attach all W-2s issued to your parent(s) in 2018
D. 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. Warning! If you
purposely give false or misleading information you may be fined, sentenced to jail, or both.
Student Signature: _____________________________________________________ Date: ___________________
Parent Signature: ______________________________________________________ Date: ___________________
This worksheet must be signed and dated to be valid. Electronic and/or digital signatures are not valid.
Louisiana College – Financial Aid Office – 1140 College Dr Box 582 Pineville, La. 71359
Phone (318) 487-7386 – Fax (318) 487-7449 – Email: financial_aid@lacollege.edu
https://lacollege.edu/campus-life/financial-aid/
A. Student Information
Student’s Name: ________________________________________________
LC ID: ________________________
Clear Form
IRS Data Retrieval Tool
and Tax Return Transcripts Instructions
How to use the IRS Data Retrieval Tool in FAFSA
The best way to verify tax return information is by using the IRS Data Retrieval Tool which is part of the FAFSA on the Web
application. If the student or parent(s) have not already used the tool,
o Go to www.studentaid.gov
o Login to the student’s FAFSA using their FSA ID (https://fsaid.ed.gov/npas/index.htm)
o Select Make FAFSA Corrections and then enter a Save Key
o Navigate to the Financial Information section of the application
o Follow the on-screen instructions. Based on your answers FAFSA will determine if the student or parent(s) can use the IRS Data Retrieval Tool
to transfer 2019 IRS income tax information into the FAFSA. If eligible to use the tool you will see a button that says Link to IRS
o Click the Link to IRS button which will redirect you to the Internal Revenue Service web site. A message will display explaining you are
‘leaving FAFSA on the web’. To continue with transferring your information, click Proceed to IRS site Notice: for parent’s, you must enter the
parent’s FSA ID before clicking the Link to IRS button.
o Generally most, if not all, of the following fields’ information is populated into the corresponding fields based on the answers reported on the FAFSA: First
Name, Last Name, Social Security Number, Date of Birth and filing status. However, if this information is not pre-populated you will need to enter it.
o Enter your address (must match your 2019 Federal Income Tax Return), city, state and zip code. Click Submit in the bottom right corner of the page.
o To transfer the data, click the box to place a checkmark under Transfer My Tax Information into the FAFSA section and then click the
Transfer Now button.
Once you’ve transferred the data into FAFSA you will see Transferred from the IRS next to each question where the information was transferred.
Notice: do not click ‘save’ and exit the application as you still need to finish the rest of the application. At the end of the application you need to
make sure you, and your parent (if applicable), sign your FAFSA using your FSA ID.
How to request your 2019 Tax Return Transcripts from the IRS
From the IRS website, you can request a tax return transcript through their Get Transcript Online or Get Transcript by Mail options. You can also
contact the IRS by phone to request your tax return transcript. Note: the method you used to file your return and whether you have a refund or balance
due, affects your current year transcript availability.
Get Transcript Online
Get Transcript by Mail
Get Transcript by Phone
To use this service you need:
• Full Name;
• Email;
• Date of birth;
• Your Social Security Number or Individual Tax
Identification Number (ITIN);
• Tax Filing Status;
• Current address;
• Personal account number from a credit card,
mortgage, home equity loan, home equity line of
credit or car loan and,
• Mobile phone with your name on the account.
Note: if account setup is successful you will be able
to download and/or print your tax return transcript.
To use this service you need:
• Your Social Security Number or Individual
Tax Identification Number (ITIN);
• Date of birth and,
• Mailing address from your latest tax return
Note: transcripts generally arrive in 5-10
calendar days to the address the IRS has on file
for you. The IRS will never send an email
requesting that you obtain or access your
transcripts. If you receive such a notice, please
forward to the IRS fraud group at
phishing@irs.gov.
Call (800) 908-9946 and follow the
telephone prompts.
Notice: Be sure to request an IRS Tax Return Transcript – not an IRS Tax Account Transcript.
How to request an IRS Verification of Non-Filing Letter for 2018
Go to the IRS website at https://www.irs.gov/ and click on Search Forms & Instructions. On this page click to select Form 4506-T and
follow the instructions on the form. IRS Verification of Non-Filing Letters can be requested by checking box 7 and 8 (if no W-2s
provided) on IRS Form 4506-T. Notice: 2019 IRS Verification of Non-Filing Letters must be dated on or after October 1, 2019.
2021-2022 Dependent
V5 Aggregate Verification Worksheet
Louisiana College – Financial Aid Office – 1140 College Dr Box 582 Pineville, La. 71359
Phone (318) 487-7386 – Fax (318) 487-7449 – Email: financial_aid@lacollege.edu
https://lacollege.edu/campus-life/financial-aid/
Page2
DO NOT COMPLETE THIS SECTION IN ADVANCE
F. Identity and Statement of Educational Purpose (To be signed at the institution)
The student must appear in person at Louisiana College to verify his or her identity 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.
G. Identity and Statement of Educational Purpose (To be signed in the presence of a notary)
If the student is unable to appear in person at Louisiana College 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.
H. Statement of Educational Purpose
I certify that I ________________________________________ am the individual signing this Statement
(Print Student’s Name)
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 Louisiana College for 2021-2022
________________________________________________________________ _________________
(Student’s Signature) (Date)
_________________________
(Student’s ID Number)
I. Notary’s Certificate of Acknowledgement
State of _______________________________________ City/Parish of ___________________________________
On_____________________, before me, _____________________________________________, personally appeared,
(Date) (Notary’s name)
____________________________________________________, and provided to me on the basis of satisfactory
(Printed name of signer)
evidence of identification ______________________________________________ to be the above-named person who
(Type of unexpired government-issued photo ID provided)
signed the foregoing instrument.
WITNESS my hand and official seal
(Seal) _________________________________________________
(Notary Signature)
My commission expires on ______________________
E. Student Information
Student’s Name: ________________________________________________
LC ID: _________________________
2021-2022 Dependent
V5 Aggregate Verification Worksheet
Louisiana College – Financial Aid Office – 1140 College Dr Box 582 Pineville, La. 71359
Phone (318) 487-7386 – Fax (318) 487-7449 – Email: financial_aid@lacollege.edu
https://lacollege.edu/campus-life/financial-aid/
Page3
J. High School Completion Status
High School Graduate/Equivalency – Check the box of the document you will attach to this worksheet:
☐ The original high school diploma or official high school transcript which includes the graduation date
☐ The student’s original General Education Development (GED) certificate, an official GED transcript that indicates the student
passed the exam, or an original state-authorized high school equivalent certificate.
☐ Students who completed secondary education in a foreign country, a copy of the “secondary school leaving certificate” or
other similar document*
☐ Official academic transcript of a completed two-year program acceptable for full credit toward a bachelor’s degree
☐ 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.
Non High School Graduate:
☐ I do not meet any of the statements above. Students who do not have a high school diploma or its equivalent and are beyond
the age of compulsory education are not eligible to receive financial aid unless they meet certain eligibility criteria regarding
prior college enrollment and may be considered under former Ability-to-Benefit (ATB) regulations. The Financial Aid Office
will determine if you meet these requirements.
Did you attend college classes prior to July 1, 2013?
☐ YES ☐ NO
College Name*: _____________________________________________ Major/Program of Study: ___________________
*If you did not attend FRC, you must attach official college transcript(s).
Did you officially register for college prior to July 1, 2013?
☐ YES ☐ NO
College Name: ______________________________________________ Major/Program of Study: ___________________
Are you currently enrolled in an eligible career pathway? ☐ YES ☐ NO
K. 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. Warning! If you
purposely give false or misleading information you may be fined, sentenced to jail, or both.
Student Signature: _____________________________________________________ Date__________________
This worksheet must be signed and dated to be valid. Electronic and/or digital signatures are not valid.
For Office Use Only
Identity and Statement of Educational Purpose:
☐ Copy of original unexpired valid government-issued photo identification (ID) presented to institutional official (financial aid staff)
☐ Identification Type:
Institutional Official Name:
Institutional Official Signature: Date:
High School Completion Status:
☐ Acceptable documentation in file
☐ Type of documentation:
☐ Approved
☐ Denied
Comment(s):
Processed/Reviewed By:
Date:
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2021-2022 Dependent V5 Aggregate Verification Worksheet (Louisiana College)

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Completed 29 January 2021

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