Fillable 2021-2022 Quincy College Verification Statement - Dependent Student (Quincy College)

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2021-2022 Quincy College Verification Statement - Dependent Student (Quincy College)

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The 2021-2022 Quincy College Verification Statement - Dependent Student (Quincy College) form is 2 pages long and contains:

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  • 10 check-boxes
  • 79 other fields

Country of origin: US
File type: PDF

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2021-2022 Quincy College Verification Statement - Dependent Student
Step 1 - Student Information
_________________________________________ ___________________
Last Name First Name Middle Quincy College Student ID #
_________________________________________________________________________________________________
Street Address (include apt. #) City State Zip Code
_____________________________ ______________________________________________________
Preferred Phone Number Email Address
Step 2 - Household Information
List the members of your parent(s)’ household below. Be sure to include:
•Yourself
•Your parent(s) (including step-parent); do not include your non-custodial parent
•Your parent(s)' other dependent children if your parent(s) will provide more than half of their
support from July 1, 2021 through June 30, 2022
•Other people only if they now live with your parent(s) and your parent(s) will provide more
than half of their support from July 1, 2021 through June 30, 2022
•Provide college information for those students attending at least half-time during 2021-22 in
a program leading to a degree, diploma, or certificate
Your 2021–2022 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, the Financial Aid Office may
ask you to confirm the information you and your parent(s) reported on your FAFSA. To verify that you
provided correct information, the Financial Aid Office 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 whose information was submitted on the FAFSA
must complete and sign this worksheet, attach any required documents, and submit this form and the
required documents to the Financial Aid Office.
Step 3 - Student's Tax Filing Status - Calendar Year 2019
Have you or will you be required to file a 2019 U.S. federal income tax return?
YES
Check the box that applies:
☐ I have used the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer 2019 IRS income information into
either the initial FAFSA or when making a correction to the FAFSA.
☐ I am unable or choose not to use the IRS Data Retrieval Tool in FAFSA on the Web, and I will submit to the Financial Aid
Office a 2019 IRS Tax Return Transcript or signed Federal Tax Return and W-2 forms. You can go to www.irs.gov to get a tax
return transcript.
NO, and I had no earnings from work. I was not required to file a tax return.
NO, but I had some earnings from work. I was not required to file a tax return. You must list all
employers in the box below and submit 2019 W2 or 1099 forms you received. If you were not required to file a 2019 tax
return, please complete the box below.
Employer’s Name
2019 Amount Earned
Step 4 - Parent's Tax Filing Status - Calendar Year 2019
Have your parent(s) filed or will they be required to file a 2019 U.S. federal income tax return?
YES
Check the box that applies:
☐ I have used the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer 2019 IRS income information into
either the initial FAFSA or when making a correction to the FAFSA.
☐ I am unable or choose not to use the IRS Data Retrieval Tool in FAFSA on the Web, and I will submit to the Financial Aid
Office a 2019 IRS Tax Return Transcript or signed Federal Tax Return and W-2 forms. You can go to www.irs.gov to get a tax
return transcript.
NO, and I had no earnings from work. I was not required to file a tax return. In addition, you must
provide IRS documentation of parent(s)’ non-filer status. Go to www.irs.gov to obtain a “Verification of Non-filing letter”
from the IRS.
NO, but I had some earnings from work. I was not required to file a tax return. You must list all
employers in the box below and submit 2019 W2 or 1099 forms you received. If you were not required to file a 2019 tax
return, please complete the box below. In addition, you must provide IRS documentation of parent(s)’ non-filer status. Go to
www.irs.gov to obtain a “Verification of Non-filing letter” from the IRS.
Employer’s Name
2019 Amount Earned
Step 5 – Certification
I certify all the information reported is complete and correct (the student and at least one parent
listed on the FASFA must sign):
Student Signature Date
Parent Signature Date
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2021-2022 Quincy College Verification Statement - Dependent Student (Quincy College)

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Completed 3 February 2021

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