2019-20 Verification Worksheet for Independent 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 Information
List the people in your household, including:
Yourself (the ‘student’), and your spouse if you were married when you signed the FAFSA and
Your dependent children, if you will provide more than half of their support * from July 1, 2019 through June
30, 2020, even if they do not live with you, and;
ther people if they live with you, and you provide more than half of their support* and will continue
rovide 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.
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Student ID Number: S
Section 2: Income Information
o If you and your spouse 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, 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 onGet a Transcript Online” orGet a Transcript by Mail” or call 1-800-908-9946. Be sure to order the IRS
TaxReturn” Transcript. If you and your spouse did not file 2017 taxes jointly, both you and your spouse should
submit a Tax Return Transcript.
o If you and/or your spouse did not file a 2017 Federal Income Tax Return, you are required to submit a
Statement of Non-Filing and all 2017 W2s. To receive 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, please contact the Financial Aid Office.
o If you (the student) or your spouse 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 Spouse
electronically on FAFSA.
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:
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