Fillable A. Student Information (Northwest State Community College)

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A. Student Information (Northwest State Community College)

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Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
Your FAFSA was randomly selected by the U.S. Department of Education for a review process called “Verification.” Verification must be
completed before your financial aid awards will be determined. If there are differences between your FAFSA and this information, we will
update your FAFSA and recalculate your Expected Family Contribution (EFC). Complete verification as soon as possible so that your financial
aid won’t be delayed. Your financial aid administrator will help you.
A. Student Information
Last Name First Name M.I
NSCC ID number
Street Address (include apt. no.)
Date of Birth
City, State, Zip Code
Phone Number
B. Household Information
List the people your parent(s) will support between July 1, 2019 and June 30, 2020. Include:
Yourself and your parent(s) (including a stepparent) even if you don’t live with your parents.
Your parent’s other children if (a) your parent(s) provide more than half of their support, or (b) if the other children would be
required to provide parental information were they to complete a FAFSA for 2019-2020. Include children who meet either of
these standards, even if they do not live with your parent(s).
Other people if they now live with your parent(s), and your parent(s) now provide more than half of their support and will
continue to provide more than half of their support through June 30, 2020.
Write the name of the college below for any household member, excluding your parent(s), who 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, 2019, and June
30, 2020. If more space is needed, attach a separate page with the student’s name and student ID at the top.
Household member name
Age
Relationship to student
College (if attending)
Will be enrolled
at least half-time
(check Yes or No)
1.
SELF
NSCC
Yes No
2.
Yes No
3.
Yes No
4.
Yes No
5.
Yes No
C. Student Income Information
Check one of the following:
_____ Student filed a 2017 Federal Income Tax return.
____ I used the FAFSA IRS Data Retrieval Tool ____ I ordered an IRS Tax Return Transcript ___ Provide a signed copy of 2017 Form 1040
_____ Student was not employed and had no income from work in 2017.
_____ Student was employed in 2017 and did not file taxes, and is not required to file a tax return. Please complete the table below.
You are required to attach copies of all 2017 IRS W-2 forms issued to the student if not filing a federal tax return. List every
employer even if they did not issue an IRS W-2.
Employer’s Name
2017 Amount Earned
2017 W-2 Attached?
Example: ABC Company
$1,005.75
Yes
By signing this worksheet, I certify that all the information reported on it is completed and correct.
Student Signature
Date
2019-2020 Dependent Aggregate
Verification Group V5
Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
Student Name:
NSCC ID number:
D. Parent(s) Income Information
Parent(s) Marital Status:
___ Single ___ Married/Remarried ___ Separated/Divorced/Widowed ___Unmarried, both parents living together
Check one of the following:
_____ Parent(s) filed a 2017 Federal Income Tax return.
____ Parent(s) used the FAFSA IRS Data Retrieval Tool ___ Parent(s) ordered an IRS Tax Return Transcript ___ Provide a signed copy
of 2017 Form 1040
_____ Parent(s) was not employed and had no income from work in 2017. Must provide Verification of Non-Filing Letter from IRS.
_____ Parent(s) was employed in 2017 and did not file taxes, and is not required to file a tax return. Please complete the table
below. You are required to attach copies of all 2017 IRS W-2 forms issued to the student if not filing a federal tax return. List
every employer even if they did not issue an IRS W-2. Must provide Verification of Non-Filing Letter from IRS.
Employer’s Name
2017 Amount
Earned
Was a W-2 Issued
by employer?
2017 W-2
Attached?
Example: ABC Company
$1,005.75
Yes
Yes
By signing this worksheet, I certify that all the information reported on it is completed and correct.
Parent Signature
Date
E. Tax Information
Both the student and the parent(s) are required to submit processed 2017 Federal Tax information. The only acceptable
methods to submit tax information are listed below:
IRS Data Retrieval Tool – Directly import your 2017 IRS data into your 2019-20 FAFSA by logging into fafsa.gov and select
“Make Correction”. Make sure to use the Data Retrieval Tool for both the student and the parent.
Keep in mind that if your parent’s are married, but filed taxes separately, the data retrieval tool will not work and you will
need to order tax return transcripts for each parent (see information below).
IRS Tax Return Transcript – Submit your 2017 Tax Return Transcript. You can order the transcript by online at irs.gov or via
automated telephone request by calling 1-800-908-9946. You may also complete IRS Form 4506-T and check mark box 6a.
Please make sure you request an IRS Tax Return Transcript NOT the IRS Account Transcript.
Also accepting a signed copy of 2017 Form 1040.
Verification of Non-Filing Letter – If your parent(s) did not file 2017 taxes, and are not required to file taxes, then they must
complete and return a Verification of Non-filing Statement Form and request a Verification of Non-Filing Letter from the IRS by
submitting IRS Form 4506-T, check marking box 7.
Amended Taxes -- If the student or parent filed an amended 2017 IRS tax return, please submit your original 2017 IRS Tax
Return Transcript and a signed copy of the 2017 IRS Form 1040X that was filed with the IRS.
Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
F. Proof of Identity – Student must appear in the financial aid office and provide proof of identity
The student must appear in person at Northwest State Community 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:
Identity and Statement of Educational Purpose
(To Be Signed at the Institution)
I certify that I, ____________________________ am the individual signing this Statement of Educational Purpose and that
(Printed Student’s Name)
the Federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending
Northwest State Community College for 2019-2020.
____________________________________________ N _________________
Student Signature Student ID Date
____________________________________________ ___________________________________________
Financial Aid Staff printed name Financial Aid Staff Signature
If the student is unable to appear in person at Northwest State Community 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 notarized 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.
Identity and Statement of Educational Purpose
(To Be Signed in the Presence of a Notary)
I certify that I, ____________________________ am the individual signing this Statement of Educational Purpose and that
(Printed Student’s Name)
the Federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending
Northwest State Community College for 2019-2020.
____________________________________________ N _________________
Student Signature Student ID Date
Notary’s Certification of Acknowledgement
State of ________________________________________City/County of________________________________________
On _________________________________________, before me, ____________________________________________
(Date) (Notary’s Name)
personally appeared, ____________________________________________, and proved to me on 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 ____________________
(Date)
Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
Student Name:
NSCC ID number:
G. High School or Equivalent Completion
Please initial the following statement and provide one of the following documents to indicate the student’s high school
completion status when the student begins the college in 2019-2020:
A signed copy of the student’s final, official high school transcript. The transcript must be sent directly from the high
school.
A state certified transcript showing the student passed a state-authorized examination that the state recognizes as
equivalent of a high school diploma (GED test). The GED transcript must be sent directly from the state in which the
GED was issued.
For a student who was homeschooled, please submit a transcript, or the equivalent, signed and dated 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
_______ I (student) have submitted a final high school transcript or other equivalent documentation to Northwest State
Community College that shows evidence of graduation or proof of equivalent from an accredited high school or
educational institution.
H. Certification and Signatures
By signing this worksheet, I certify that all the information reported on this worksheet is complete and correct. A delay in processing will result if this
form is not signed or if there is conflicting information on this worksheet. WARNING: IF you purposely give false or misleading information on this
form, you may be subject to fines and/or other penalties.
Student Signature
Parent Signature
Northwest State Community College does not discriminate on the basis of race, color, national origin, sex, gender identity, disability, religion
or age in its programs or activities.
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Completed 3 October 2020

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