Fillable Form 202: -22 VERIFICATION WORKSHEET 1 (Sage Colleges)

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Form 202: -22 VERIFICATION WORKSHEET 1 (Sage Colleges)

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BROWSE SAGE COLLEGES FORMS

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202
1
-22 VERIFICATION WORKSHEET
D
e
pendent
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
legal parent(s) that would provide more than half of your support, even if you choose not to live with your
parent(s). A legal parent is a biological, adoptive, and/or step-parent;
• Your parents’ other children, even if they do not live with your parent(s), if (a) your parents 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 when applying for federal aid;
• Other people if they now live with your parents and your parents 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
.
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’ if not enrolled
Ex
ample
: Sally Sage
18 self
None
Colleg
e
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
FAC21V1D
STEP 3: STUDENT INCOME INFORMATION
Plea
se
check the box that applies to the student. Provide all applicable documentation as noted in italics. CHECK
ONLY ONE BOX. (please include student name and student ID on all documents submitted)
I, the STUDENT, did not earn any wages
in 2019 and I did not file 2019 Tax Return. STOP. Sign below.
Proceed to Step 4.
I, the STUDENT, earned wages but did not file and was not required to file a 2019 IRS Tax Return.
Complete the list below for each employer for you during 2019, along with any other sources of inc
ome.
You are required to provide copies of IRS W-2 forms for each employer listed.
2019 Income Information: January 1, 2019 – December 31, 2019
Source of Employment Income Check if you
received a W-2
Wages
$
$
$
TOTAL
$
Sign below. Proceed to Step 4.
I, the STUDENT, 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. Sign below. Proceed to Step 4.
I, the STUDENT, am 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. STOP.
Sign below. Proceed to Step 4.
Page 2
FAC21V1D
STEP 4: PARENT INCOME INFORMATION
As
the
parent(s) of the above student, please check the box below that correctly indicates how you will submit federal
IRS
tax
information to us. CHECK ONLY ONE BOX. Provide all applicable documentation as noted in italics.
** Important: p
lease include student name and ID on all documents submitted**
-OR-
-OR-
I
, the parent, certify that the information provided on this form is true and correct to the best
of our knowledge.
I
understand that if information differs from the FAFSA, it may result in a
change in eligibility for federal funds.
Parent Signature: ____________________________________________________
Date: _____________
I, the parent (and parent’s spouse if applicable), 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. Sign below.
I, the parent (and parent’s spouse if applicable), filed 2019 taxes, and I am 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 applicable schedules or a 2019 IRS Tax Transcript*. STOP. Sign below.
*If you filed a tax return in a foreign country
, submit a copy of the foreign tax return transcript, translated into English and converted into US dollars.
I, the parent (and parent’s spouse if applicable), did not file and was not required to file a 2019 IRS Tax
Return. Complete the list below for each employer for y
ou (the parent) and your spouse during 2019, along with
any other sources of income. You are required to provide an IRS Verification of Non-filing Letter and
copies of IRS W-2 forms for each employer listed.
2019 Income Information: January 1, 2019 – December 31, 2019
Source of Employment Income
(put NONE if not employed)
Check if you
received a W-2
Wages
(put 0 if no wages earned)
$
$
$
TOTAL
$
If
n
o wages were earned, enter “0” in the box above labeled “Total.”
Return completed form to: Russell Sage College, Attn:
Financial Aid Office, 65 First St
reet, Troy, NY 12180
Please note: This form must hav
e 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 3
FAC21V1D
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Form 202: -22 VERIFICATION WORKSHEET 1 (Sage Colleges)

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Completed 1 February 2021

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