Fillable 2021-22 VERIFICATION WORKSHEET (Sage Colleges)

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2021-22 VERIFICATION WORKSHEET (Sage Colleges)

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2021-22 VERIFICATION WORKSHEET
Independent
STEP 1: STUDENT INFORMATION
Print Student’s Name: ____________________________________________________________________________
Student ID: ______________________________________________________________________________________
STEP 2: FAMILY SIZE & # IN COLLEGE:
In the chart below, write in the name, age, and relationship of all the people in the household, be sure to include:
• Yourself
• Your spouse, if you are married;
• You or your spouse’s children, if you or your 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 you.
• Other people if they now live with you, and you or your spouse provide 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.
Be sure to indicate if each household member listed below will be attending a college at least half time between July 1,
2021 and June 30, 2022 enrolled in a degree, diploma, or certificate program.
Full Name Age Relationship
Name of College OR Check NONE
Example: Steve Sage
18
self
None
College Name: Russell Sage College
None
College Name:
None
College Name:
None
College Name:
None
College Name:
None
College Name:
None
College Name:
None
College Name:
None
College Name:
Page 1
FAC21V1I
STEP 3: STUDENT INCOME INFORMATION
Please check the box that applies to you (the student) and your spouse (if married). Provide all applicable
documentation as noted in italics. CHECK ONLY ONE BOX.
-OR-
-OR-
-OR-
STEP 4: STUDENT CERTIFICATION
I certify that the information provided on this form is true and correct to the best of my/our knowledge. I
understand that if information differs from the FAFSA, it may result in a change in eligibility for federal funds.
Student Signature: ____________________________________________________ Date: _____________
I, the student, and my spouse, (if married), did not earn any wages in 2019 and I/we did not file 2019 Tax Return.
STOP. Proceed to Step 4. ** You (& your spouse) must submit a 2019 IRS Verification of Non-filing letter**
I, the student, and my spouse (if married), did not file and was not required to file a 2019 IRS Tax Return.
Complete the list below for each employer for you and your spouse (if married) during 2019, along with any
other sources of income. You are required to provide copies of IRS W-2 forms for each employer listed,
along with a 2019 IRS Verification of Non-filing letter.
2019 Income Information: January 1, 2019 – December 31, 2019
Source of Employment Income Check if you
received a W-2
Wages
$
$
$
TOTAL
$
Proceed to Step 4.
I, the student, and my spous
e (if married), filed 2019 taxes, and have used the IRS Data Retrieval Tool in
FAFSA on the Web to transfer 2019 IRS income tax return information into the FAFSA. STOP. No further
information is needed on this form. Proceed to Step 4.
I, the student, and my spouse (if married), are unable or choose not to use the IRS Data Retrieval Tool in FAFSA on
the Web, and instead will provide the school a SIGNED 2019 IRS Tax Return 1040 and all applicable schedules or a 2019
IRS Tax Transcript. STOP. No further information is needed on this form. Proceed to Step 4.
Return completed form to: Russell Sage College,
Attn: Financial Aid Office, 65 First Street, Troy, NY 12180
Please note: This form must have a "wet" signature, we cannot accept electronic signatures.
The safest method to submit the form is via mail or fax, as email may not be secure.
Page 2
FAC21V1I
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2021-22 VERIFICATION WORKSHEET (Sage Colleges)

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Completed 1 February 2021

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