2020-2021 Verification Worksheet for Dependent Student Form 1
Student ID
S ________________________
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 (thestudent), andyour 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 infor mation if they were completing a FAFSA for2020-2021, a nd;
Other people if they live with yourparent(s), andyour parent(s) providemore than half of their support* and will
continueto pr ovide more than half of their supportfr om July 1,2020throughJune30, 2021.
Family Information
*Support includes money, gifts, loans, housing, food, clothes, car, medical/dental care, college tuition, etc.
Full Name Age Relationship to
The name of the college attending from July 1, 2020 to
June 30, 2021 and will be enrolled in at least half time, in an
eligible degree and/or certificate program.
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Student ID
Section 2: Income Information
If you and/or your parent(s) filed a 2018 Federal Income Tax Return, you must ei ther give the Internal Revenue
Service (IRS) permission to transfer all 2018 tax i nformation directly to the FAFSA through the IRS Data Retrieval
Tool (DRT), or submit a 2018Federal Tax Return Transcript, or a s igned copy of the 2018 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 orGet a Transcript by Mail or call 1-800-908-9946. Be sure to order the
IRS Tax Return” Tra nsc ript. If there aretwo parents listed on your FAFSA andthey didnot file 2018 taxes jointly,
both parents listed on the FAFSAshoulds ubmit a Tax Return Tr ansc ript.
o If your parent(s) did not file a 2018 Federal Income Tax Return, they are required to submit a Statement of
Non-Filing and all 2018 W2s. To obtain a 2018 Statement of Non-Filing, go to https://www.irs.gov/pub/irs-
pdf/f4506t.pdf andc omplete Form 4506-T with Box 7 checked. Ifyou are unableto obtain the Statement of Non-
Filing, contact the Financial Aid O ffic e.
o If you (the student) or your parent(s) arenot able to l ocate your 2018 W2s, you can request to recei ve 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 Parent
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 income earned from work in 2018 as listed below, but has not filed and was not required
to file a tax return and already has or plans to submit all 2018 W2's.
If this box is selected; 2018 wage information must be completed below.
3. Had no income, will not file, and was not required to file, a 2018 IRS Income Tax Return.
2018 Wage Information (Only Non-Filers)
Only complete wage information for eachpersonwho selected Option2 in the previous chart.
Non-Tax Filer Name of Employer 2018 Income Earned
If more space is needed, attach a separate page with student’s name andstudent 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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