Fillable 2021-2022 V5-VERIFICATION SHEET (1/2) (Andrews University)

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2021-2022 V5-VERIFICATION SHEET (1/2) (Andrews University)

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LAST NAME ___________________________________________ FIRST NAME __________________________________
LAST 4 DIGITS OF SOCIAL SECURITY NUMBER ________________ ANDREWS UNIVERSITY ID NUMBER _______________
STUDENT’S EMAIL ADDRESS _____________________________ TELEPHONE/MOBILE ___________________________
A WORD FROM STUDENT FINANCIAL SERVICES: Your application was selected for review in a process called
“Verification.” In this process, we will be comparing information from your application with 2019 Federal Tax Return,
and/or with W2s or other financial documents. The U.S. Dept. of Education requires us to collect this information before
awarding federal aid. If there are differences between your application information and your financial documents,
corrections may need to be made to your FAFSA. Complete this form and submit it to the Office of Student Financial Services
as soon as possible to ensure prompt processing. Warning: If you purposely give false or misleading information on this
sheet, you may be fined, and/or be sentenced to jail by the federal government.
> For more information, visit www.andrews.edu/services/sfs/general_information/aid/verification.html.
> Were you required to provide parent information on FAFSA?
NO. Then you are classified as Independent. Include the following people in the box below:
> yourself, your spouse if married, and
> your children, if you will provide more than half of their support from July 1, 2021 through June 30, 2022 and
> other people, if they now 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, 2021 through June 30, 2022.
YES. Then you are classified as Dependent. Include the following people in the box below:
> yourself and your custodial parent(s), and
> your custodial parent(s)’ other children, if (a) your parent(s) will provide more than half of their support from July 1, 2021
through June 30, 2022, or (b) the children would be required to provide parental information if completing a FAFSA for
2021-22, and
> other people if they now live with your parent(s), and your parent(s) provide more than half of their support and will
continue to provide more than half of their support from July 1, 2021 through June 30, 2022.
NOT SURE? To determine who is considered a custodial parent for purposes of this form, see below:
> If your parents are living together and/or married to each other, include them both in the household listing.
> If your parent is widowed or single, list this parent. If your widowed parent is remarried as of the day you completed the
FAFSA, also include the person whom your parent married, i.e. your stepparent.
> If your parents have divorced or separated, only include in the household listing the parent with whom you live the most.
If you did not live with one parent more than the other, only include the parent who provides more financial support to
you. If this parent has remarried as of the day you completed the FAFSA, also include the person whom your
parent married, i.e. your stepparent.
Full names of ALL
household members
Age
Relationship to
student
Will he/she be enrolled in a degree
program at a college/university at
least half-time in 2021-22?
If enrolled, what
type of program?
Name of
college/university
UG GRAD
Self
☐
Yes
☐
No
☐
☐
☐
Yes
☐
No
☐
☐
☐
Yes
☐
No
☐
☐
☐
Yes
☐
No
☐
☐
☐
Yes
☐
No
☐
☐
☐
Yes
☐
No
☐
☐
☐
Yes
☐
No
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☐
2021-2022 V5-VERIFICATION SHEET (1/2)
SECTION 1-HOUSEHOLD INFORMATION
11/12/20
NAME ___________________________________________________
ID/ LAST 4 DIGITS OF SSN _________________________________
Your application requires IRS tax data. We recommend that you use the IRS Data Retrieval Tool (IRS DRT) on the FAFSA to
link directly to the IRS database. To address security concerns, the tax return information you transfer from the IRS will no
longer be displayed on www.studentaid.gov or the IRS DRT web page. Instead you will see “Transferred from the IRS” in the
appropriate fields on www.studentaid.gov. If you and/or your custodial parent(s) or spouse filed a tax return but were not
presented with the option to link directly to the IRS database, you must provide a signed copy of the 2019 income tax return
(Form 1040) for you and your custodial parent(s) or spouse. You may also try to download a free Tax Return Transcript online
at http://www.irs.gov/individuals/get-transcript or call 1-800-908-9946 and request a copy to be mailed. You may also need
to submit copies of all W-2s and/or 1099 forms for 2019.
Foreign, US territory, or commonwealth residents: Please submit a copy of your 2019 tax transcript. If no taxes were filed,
we can accept a Wage & Tax Statement or its equivalent from each employer indicating total income earned and taxes paid
during January – December 2019.
> Check the situation below as it applies to you (the student) & your parent/spouse: ONLY ONE PER STUDENT & PARENT/SPOUSE
Student Parent/Spouse
Have or will complete IRS Data Retrieval (data was not altered). ☐ ☐
Not eligible for IRS Data Retrieval. Will submit 2019 Tax Return Transcript(s). ☐ ☐
Did work in 2019, but did not file taxes. I am not required to file a 2019 federal tax return. ☐ ☐
Did NOT work in 2019, did not file taxes. I am not required to file a 2019 federal tax return. ☐ ☐
Did NOT file taxes, but had income in 2019 not reported on a W2. Submit 1099 and/or a signed statement of income. ☐ ☐
> Did you receive any funds in 2019 that was untaxed income?
Please list below. Do not leave any lines blank. Enter ø or N/A if an item does not apply.
> Verification of high school completion - I have: (check applicable box)
☐ received a diploma from _________________________________________(name of high school or academy) on ______________________ (date).
☐
completed a GED test, High School Equivalency Test(HiSET), Test Assessing Secondary Completion(TASC), or other State-authorized exam.
☐
completed a home school program.
☐ have completed secondary education in a foreign country.
☐
have successfully completed at least a two-year program that is acceptable for full credit toward a bachelor degree.
REQUIRED SIGNATURE(S)
STUDENT_________________________________________________________ DATE _________________________
PARENT OF DEPENDENT STUDENT ________________________________________ DATE _________________________
Mail to: Andrews University Fax to: 269.471.3228
Office of Student Financial Services Phone: 269.471.3334
4150 Administration Drive Web: www.andrews.edu/sf
s
Berrien Springs, MI 49104-0750 Email: sfs@andrews.edu
Student/Spouse
This relates to the Student Financial Information Section on the FAFSA,
Question 44. To avoid a discrepancy, make sure amounts on FAFSA and this
form match.
Sources of untaxed income Total received in 2019
Child support received $
Amounts reported on W-2 boxes
12a-12d; codes D,E,F,G,H & S
$
Other: $
This relates to Parent Financial Information Section on the FAFSA, Question
92. To avoid a discrepancy, make sure amounts on FAFSA and this form
Sources of untaxed income Total received in 2019
Child support received $
Amounts reported on W-2 boxes
12a-12d; codes D,E,F,G,H & S
$
Other: $
SECTION 2-TAX INFORMATION
SECTION 3-ADDITIONAL FINANCIAL INFORMATION
2021-2022 V5-VERIFICATION SHEET (2/2)
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2021-2022 V5-VERIFICATION SHEET (12) (Andrews University)

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Completed 26 August 2021

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