FORM PTEX16 - IDAHO STATE UNIVERSITY 19-20
FEDERAL TAX RETURN EXTENSION
PARENT(S)
The federal government requires colleges to check the accuracy of the information you
provided on your Free Application for Federal Student Aid (FAFSA
). This process is
called verification. You must complete the verification process before the Office of
Financial Aid can establish your eligibility for assistance. You must return the
information requested on this form or you will not be considered for federal financial
aid. Please return this completed form with applicable attachments to:
Office of Financial Aid, Idaho State University, Museum Building, Room 337
921 S 8
th
Ave, Stop 8077, Pocatello, ID 83209-8077
Phone: (208)282-2756 Fax: (208)282-4755 Email: finaidem.isu.edu
Web: www.isu.edu/financialaid/forms/
*Student Name:
(Use blue or black ink) Last First M.I.
*ISU ID: *Last 4 Digits of Social Security #:
(Find under Academic Tools tab on BengalWeb) *Required
INSTRUCTIONS: An individual who is required to file a 2017 IRS income tax return and has been granted a filing
extension by the IRS beyond the automatic six-month extension for tax year 2017, must provide all of the items
listed below. Please complete this form, attach the requested items, and return to the Office of Financial Aid.
• A copy of IRS Form 4868, “Application for Automatic Extension of Time to File U.S. Individual
Income Tax Return,” that was filed with the IRS for tax year 2017;
• A copy of the IRS’s approval of an extension beyond the automatic six-month extension for tax
year 2017;
• Verification of Non-filing Letter (confirmation that the tax return has not yet been filed) from the
IRS or other relevant tax authority dated on or after October 1, 2018;
• A copy of IRS Form W-2 for each source of employment income received or an equivalent
document for tax year 2017 (disregard this item if W2 forms were already submitted for the
2019-2020 academic year), and
• If self-employed, a signed statement certifying the amount of the individual’s Adjusted Gross
Income (AGI) and the U.S. income tax paid for tax year 2017
CERTIFICATION: The person signing below certifies that all of the information reported is complete and correct.
Parent Signature: Date:
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
(v. 12/14/2018) (S:\19_Forms\formPTEX16.docx)
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