2019-20 Verification Worksheet for Dependent Student Form 1
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: Household Information
Student/Parent(s) Information
List the people in your household, including:
Yourself (the ‘student’), 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, 2019 through June 30, 2020, or (b) the children would be required to provide parental
information if they were completing a FAFSA for 2019-2020, and;
Other people if they live with your parent(s), and your parent(s) provide more than half of their support* and will
continue to provide more than half of their support from July 1, 2019 through June 30, 2020.
*Support includes money, gifts, loans, housing, food, clothes, car, medical/dental care, college tuition, etc.
Full Name
Relationship to
The name of the college attending from July 1, 2019 to
June 30, 2020. Must attend at least ½ time and be
enrolled in an eligible degree and/or certificate.
Not Applicable
Not Applicable
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Student ID Number: S
Section 2: Income Information
o If you and/or your parent(s) filed a 2017 Federal Income Tax Return, you must either give the Internal Revenue
Service (IRS) permission to transfer all 2017 tax information directly to the FAFSA through the IRS Data Retrieval
Tool (DRT), or submit a 2017 Federal Tax Return Transcript, or a signed copy of the 2017 Federal 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” or “Get a Transcript by Mail” or call 1-800-908-9946. Be sure to order the
IRS Tax “Return” Transcript. If there are two parents listed on your FAFSA and they did not file 2017 taxes jointly,
both parents listed on the FAFSA should submit a Tax Return Transcript.
o If your parent(s) did not file a 2017 Federal Income Tax Return, they are required to submit a Statement of Non-
Filing and all 2017 W2s. To obtain a 2017 Statement of Non-Filing, go to https://www.irs.gov/pub/irs-
pdf/f4506t.pdf and complete Form 4506-T with Box 7 checked. If you are unable to obtain the Statement of Non-
Filing, contact the Financial Aid Office.
o If you (the student) or your parent(s) are not able to locate your 2017 W2s, you can request to receive your
Wage and Income Statement by checking Box 8 on the 4506-T.
2017 Tax Filing Status: Only select one option for each individual
Student Parent
electronically on FAFSA.
Transcript or signed 2017 IRS Federal Tax Return.
2017 as listed below, and already has or plans to submit all 2017 W2’s. If this
2017 Wage Information (Only Non-Filers)
Only complete wage information for each person who selected Option 4 in the previous chart.
Non-Tax Filer
Name of Employer
2017 Income Earned
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 pursuant to U.S. Criminal
Code and Colorado Criminal Code.
Student Signature: Date:
Parent Signature: Date:
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