Fillable ElectronicIVF Distributed (Orange County Community College)

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ElectronicIVF Distributed (Orange County Community College)

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BROWSE ORANGE COUNTY COMMUNITY COLLEGE FORMS

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*IVF*
115 South Street Middletown, NY 10940 (845)341-4190 fax (845)341-4194
1 Washington Center Newburgh, NY 12550 (845) 562-245 fax (845)220-4062
www.sunyorange.edu
1516 INDEPENDENT VERIFICATION FORM (V1 / V5 / V6)
Your 2015 -2016 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called Verification. The law says
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 the financial aid administrator at your school 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 must complete and sign
this worksheet, attach any required documents, and submit the form and other required documents to the financial aid administrator at
your school. Your school may ask for additional information. If you have questions about verification, contact your financial aid
administrator as soon as possible so your financial aid will not be delayed.
A. STUDENT INFORMATION
Student ID #__________________________
First Name:__________________________________MI_____Last Name:_____________________________________
Date of Birth:___/____/_____ Phone:(_______)______ -________ E-mail_____________________________________
B. INDEPENDENT STUDENT'S FAMILY INFORMATION List the people in your household below: Include:
Yourself
Your spouse, if married
Your children, if any, that you will provide more than half of their support from July 1, 2015, through June 30, 2016,
or if the child would be required to provide your information if they were completing a FAFSA for 2015 -2016. Include
children who meet either of these standards, even if they do not live with you.
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 through June 30, 2016.
If anyone listed below will be enrolled at least half time, in a degree, diploma, or certificate program at a postsecondary
educational institution any time between July 1, 2015, and June 30, 2016 you MUST include the name of the college he/she
is attending.
Full Name
Age
Relationship
College
Attending 6+
credits
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
C. INDEPENDENT STUDENT'S OTHER INFORMATION TO BE VERIFIED
Did someone in the student's household (listed in Section B) receive benefits from the Supplemental Nutrition Assistance
Program/SNAP (formerly known as food stamps) any time during the 2013 or 2014 calendar years?
No
Yes, one of the persons listed in Section B of this worksheet received SNAP benefits in 2013 or 2014. I will
provide documentation from the issuing agency (copy of benefit card is not acceptable).
Did you or your spouse, if married, pay child support in 2014?
No
Yes, the student (and, if married, the student's spouse) who is listed in Section B of this worksheet, paid
child support in 2014
*
*1516*
*IVF* 1516 INDEPENDENT VERIFICATION FORM (V1 & V5)
If yes, I certify that I paid child support in 2014. I have listed below the names of the persons to whom the child support was paid, the
names of the children for whom the child support was paid and the total amount of child support paid in 2014 for each child. I also attest
that I have not included these children as members of my household size. (Parents can either include these children as members of the
household *or* include the amount of child support paid but may not include these children as members of the household and also list
child support paid.
Name who paid the child support
For whom support was
Yearly amount paid
D. INDEPENDENT STUDENT'S TAX INFORMATION TO BE VERIFIED
Did you file / will file a 2014 tax return?
Yes, the student (and, if married, the student's spouse) filed a 2014 federal tax return.
No, the student (and, if married, the student's spouse) DID NOT file a 2014 federal tax return.
IMPORTANT INFORMATION: If you (or your spouse, if married) filed, or will file, an amended 2014 IRS tax return, you
must contact your financial aid administrator before completing this section. The best way to verify income is by using the
IRS Data Retrieval Tool that is part of FAFSA online. If you have not already used the tool, go to FAFSA.gov, log in to your
FAFSA record, select “Make FAFSA Corrections,” and navigate to the Financial Information section of the form. From there,
follow the instructions to determine if you are eligible to use the IRS Data Retrieval Tool to transfer 2014 IRS income tax
information into your FAFSA. It takes up to two weeks for IRS income information to be available for the IRS Data Retrieval
Tool for electronic IRS tax return filers, and up to eight weeks for paper IRS tax return filers. If you need more information
about when, or how to use the IRS Data Retrieval Tool see your financial aid administrator.
I, the student (and spouse, if married):
used the IRS Data Retrieval Tool in FAFSA on the Web to transfer my income information into my FAFSA.</text>
have not yet used the IRS Data Retrieval Tool, but I will use the tool to transfer my income information into my
FAFSA.
am unable to use the IRS Data Retrieval Tool in FAFSA on the Web -I will submit 2014 IRS tax return transcript(s) to
SUNY Orange.
choose not to use the IRS Data Retrieval Tool in FAFSA on the Web - I will submit 2014 IRS tax return transcript(s)
to SUNY Orange.
was not employed and had no income earned from work in 2014.
was employed in 2014 and will list below the names of all employers and the amount earned from each employer in
2014.
*1516*
*IVF*
115 South Street Middletown, NY 10940 (845)341-4190 fax (845)341-4194
1 Washington Center Newburgh, NY 12550 (845) 562-245 fax (845)220-4062
www.sunyorange.edu
1516 INDEPENDENT VERIFICATION FORM (V1 & V5)
Complete the section below ONLY if you were employed in 2014 AND DID NOT file a 2014 tax return.
You MUST provide documentation of all monies earned (e.g. copy of W-2).
Employer's Name
Total Amount Earned in 2014
Received a W-2
E. CERTIFICATIONS AND SIGNATURES
Electronic Certification Agreement. By providing your “electronic” student signature, student ID # and by selecting the
“Accept" button, you consent that all of the information reported is complete and correct.
Student: Accept ___
Student Signature:______________________________________Date:___/ :__/ :_____
Spouse: Accept ___
Spouse Signature:______________________________________Date:___/ :__/ :_____
(if required)
WARNING: If you purposely give false or misleading information on the worksheet, you may be fined, be
sentenced to jail, or both.
1516*
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Completed 20 July 2020

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