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2020-2021 Verification Worksheet for Dependent Student Form 5
Student ID Number: S
Student Name: Phone Number:
Form must be completed in blue or black ink. Failure to accurately complete this form may result in a delay
of processing or change of financial aid eligibility. Additional documentation may be requested. Read
instructions carefully before completing.
Section 1: High School Completion Status
Please submit documentation to verify you have completed a high school education. Acceptable
documentation can include:
A high school diploma or a copy of an official high school transcript. Transcripts must verify graduation
completion date
GED certificate ortranscript
A transcript that indicates that you have successfully completed at least a two-year program that is acceptable
for full credit toward a bachelors degree at any participating school
Home school credential or transcript
If high school completed in foreign country, a copy of the secondary school leaving certificateor similar
document
Type of documentation submitted:
Designated institutional official:
(School official’s printed name)
Section 2: Identity
MUST BE COMPLETED & SIGNED AT THE FINANCIAL AID OFFICE
If unable to appear in person at the Financial Aid Office, you must complete this section with a notary
You must appear in person at Financial Aid Office to verify your
(Name of institution)
identity by presenting a valid unexpired 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 your photo ID.
Type of documentation submitted:
Designated institutional official:
(School official’s printed name)
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Student ID Number: S
Section 3: Statement of Educational Purpose
MUST BE COMPLETED & SIGNED AT THE FINANCIAL AID OFFICE
If unable to appear in person at the Financial Aid Office, you must complete this section with a notary
In addition, you must sign, in the presence of the institutional official, the following:
I certify that I am the individual signing this
(Students printed name)
Statement of Educational Purpose and that the federal student financial assistance
I may receive will only be used for educational purposes and to pay the cost of attending
for 2020-2021.
(Name of institution)
Student Signature: Date:
Notary Section Instructions: Please Read
This section should only be completed if you are unable to appear in person at the institution with a designated official.
This form (the original on which the seal is visible) should be mailed to the Financial Aid Office at your institution along
with the copy of the government-issued identification and high school documentation.
Notary’s Certificate of Acknowledgement
State of City/County of
On
, before me
(Date) (Notary’s name)
Personally
appeared and proved to me on the basis of
(Printed name of signer)
Sati s factory evidence
of Identification to be the above-named
(Type of unexpired government-issued ID provided)
Person who signed the foregoing instrument.
My commission expires on , 20
Notary (Print):
Notary (Signature):
(Seal)
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Student ID Number: S
Section 4: Household Information
Student/Parent(s) Information
List the people in your household, including:
Yourself (thestudent), and your parent(s);
Your parents’ other children, even if they don’t live with your parent(s), if (a) your parents will provide more
than half of their support* from July 1, 2020 through June 30, 2021, or (b) the children would be required to
provide parental information if they were completing a FAFSA for 2020-2021,and;
Other people if they live with your parent(s), and your parent(s) provide more than half oftheir support* and
will continue to provide more than half of their support from July 1, 2020 through June 30, 2021.
Family Information
*Support includes money, gifts, loans, housing, food, clothes, car, medical/dental care, college tuition, etc.
Age
Relationship to
Student
The name of the college attending from July 1, 2020 to
June 30, 2021. Will be enrolled in at least half-time ,
in an eligible degree and/or certific ate program.
THIS SPACE INTENTIONALLY
LEFT BLANK
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Student ID Number: S
Section 5: Income Information
TAX FILERS:
o If you and/or your parent(s) filed a 2018 Federal Income Tax Return, you either must give the Internal Revenue
Service (IRS) permission to transfer all 2018 tax information directly to the FAFSA through the IRS Data Retrieval
Tool, or s ubmit a 2018 Federal Tax Return Transcript, or signed 2018Federal Tax Return.
o To obtain an IRS Federal Tax Return Transcript, you may go to https://www.irs.gov/individuals/get- transcript
and click on “Get a Transcript Online orGet a Transcript by Mail” or call 1-800-908-9946. Be s ure to order the
IRS TaxReturn” Transcript. If there are two parents listed on your FAFSA and they did not file 2018 taxes jointly,
both parents l isted on the FAFSA shoulds ubmit a Tax Return Transc ript.
NON-TAX FILERS:
o
If your parent(s) did not file a 2018 Federal IncomeTax Return, they are required to submit a Statement of Non-
Fi l ing and all 2018 W2s. To receive a 2018 Statement of Non-Filing, go to https://www.irs.gov/pub/irs-
pdf/f4506t.pd f and complete Form 4506-T wi th Box 7 checked. If you are unableto obtain the Statement of Non-
Fi l ing, contact the Fi nancial Aid Office.
o If you (the student) or your parent(s) are not able to locate your 2018 W2s, you can request to receive your Wage
and I ncome Statement by checking Box 8 onthe 4506-T.
2018 Tax Filing Status: Only select one option for each individual Student Spouse
1. Has used or plans to use the IRS Data Retrieval Tool to transfer tax information electronically
on FAFSA. Or has plans to submit a copy of their 2018 IRS Federal Tax Return Transcripts or
signed 2018 IRS Federal Return.
2. Had no income, will not file, and was not required to file, a 2018 IRS Income Tax Return.
3. Has not filed, was not required to file, but had income earned from work in 2018 as listed
below and already has or plans to submit all 2018 W2s. If this box is selected; wage
information must be completed below.
2018 Wage Information (Only Non-Filers)
Only complete wage information for each person who selected Option 3 in the previous chart.
Non-Tax Filer
Name of Employer
2018 Income Earned
Student
$
$
Spouse
$
$
If more space is needed, attach a separate page with student’s name and student ID number.
By signing this document, I certify that the information is complete, true and accurate. I understand that purposely
providing false or misleading information could result in criminal prosecution, a prison sentence, and/or a fine
pursuantto U.S. Criminal Code and Colorado Criminal Code.
Student Signature:
Date:
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