Revised 11/24/2020
2021-2022 V1-I Verification Worksheet
Independent Student
Student’s Information
________________________________________________ _________________________________________
Student’s Last Name First Name M.I. Student’s Identification (ID) Number
________________________________________________
Student’s Street Address (include apt. no.)
________________________________________________ __________________________________________
City State Zip Code Student’s Email Address
________________________________________________ __________________________________________
Student’s Home Phone Number (include area code) Student’s Alternate or Cell Phone Number
Number of Household Members and Number in College (Independent Student)
Number of Household Members: List below the people in the student’s household
. Include:
The student.
The student’s spouse, if the student is married.
The student’s or spouse’s children if the student or spouse will provide more than half of the children’s support from July 1, 2021, through June
30, 2022, even if a child does not live with the student.
Other people if they now live with the student and the student or spouse provides more than half of the other person’s support and will continue to
provide more than half of that person’s support through June 30, 2022.
Number in College: Include in the space below information about any household member who is, or will be, enrolled at least half time
in a degree,
diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, 2021, and June 30, 2022, and include the
name of the college.
If more space is needed, provide a separate page with the student’s name and ID number at the top.
Full Name
Age
Relationship
College
Will be Enrolled at Least
Half Time
(Yes or No)
Self
Lurleen B. Wallace Community College
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.
Your 2021-2022 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 ask you to confirm the information you reported on your FAFSA. To verify that you provided
correct information, we will compare your FAFSA with the information on this institutional verification document and with any other required
documents. If there are differences, your FAFSA information may need to be corrected. You must complete and sign this institutional
verification document, attach any required documents, and submit the form and other required documents to us. 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-I
Student Name:_____________________________Student Number:_______________________ Page 2
Revised 11/24/2020
Verification of 2019 Income Information for Student Tax Filers
Important Note: The instructions below apply to the student and spouse if the student is married. Notify the financial aid office if the student or
spouse filed separate IRS income tax returns for 2019 or had a change in marital status after December 31, 2019.
Instructions: Complete this section if the student and spouse filed or will file
a 2019 IRS income tax return(s). 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 2019 income information that was transferred into the student’s FAFSA using the IRS DRT if that information was not changed.
Check the box that applies:
The student has used the IRS DRT in FAFSA on the Web to transfer 2019 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 2019 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 2019 IRS Tax
Return Transcript(s) or a signed copy of the 2019 IRS Tax Return and applicable schedules.
A 2019 IRS Tax Return Transcript may be obtained through:
Get Transcript by Mail Go to www.irs.gov
, click "Get Your Tax Record.” Click “Get Transcript by Mail.” Make sure to request the
“Return Transcript” and NOT the “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, click "Get Your Tax Record." Click “Get Transcript Online.” Make sure to request the
“Return Transcript” and NOT the “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 FormIRS 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.
If the student and spouse filed separate 2019 IRS income tax returns, the IRS DRT cannot be used and the signed 2019 IRS Tax Return(s)
and applicable schedules or 2019 Tax Return Transcript(s) must be provided for each.
____ Check here if a signed copy of the 2019 IRS Tax Return or the Tax Return Transcript(s) is provided.
____ Check here if a signed copy of the 2019 IRS Tax Return or the Tax Return Transcript(s) will be provided later.
Verification of 2019 Income Information for Student Nontax Filers (Please skip this portion if you filed taxes):
The instructions and certifications below apply to the student and spouse, if the student is married. Complete this section if the student and spouse
will not file and are not required to file a 2019 income tax return with the IRS.
Check the box that applies:
The student was not employed and had no income earned from work in 2019.
The student was employed in 2019 and has listed below the names of all employers, the amount earned from each employer in 2019, and
whether an IRS W-2 form or an equivalent document is provided. [Provide copies of all 2019 IRS W-2 forms issued to the student by their
employers]. List every employer even if the employer did not issue an IRS W-2 form.
If more space is needed, provide a separate page with the student’s name and ID number at the top.
Employer’s Name
IRS W-2 or an Equivalent
Document Provided?
Annual Amount
Earned in 2018
(Example) ABC’s Auto Body Shop
Yes
$4,500.00
Total Amount of Income Earned From Work
$
V1-I
Student Name:_____________________________Student Number:_______________________ Page 3
Revised 11/24/2020
Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2020 that indicates a 2019 IRS income tax
return was not filed with the IRS or other relevant tax authority
, or a 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.
____ Check here if confirmation of non-filing or a signed statement is provided.
____ Check here if confirmation of non-filing or a signed statement will be provided later.
Certification and Signature
Each person signing below certifies that all of the
information reported is complete and correct. I give LBWCC
authorization to submit corrections to my ISIR/SAR
for verification purposes.
________________________________________ ________________________
Print Student’s Name Student’s ID Number
________________________________________ ________________________
Student’s Signature (Required) Date
________________________________________ ________________________
Spouse’s Signature (Optional) Date
WARNING: If you purposely give false or
misleading information, you may be
fined, sent to prison, or both.