Fillable INCOME VERIFICATION GREEN RIVER COLLEGE - TRIO STUDENT (Green River Community College)

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INCOME VERIFICATION GREEN RIVER COLLEGE - TRIO STUDENT (Green River Community College)

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G:\TRIO\Forms and Tools\APPLICATION AND INTAKE FORMS\Income Verification\Income Verification.docx Updated 08/27/2019
INCOME VERIFICATION
GREEN RIVER COLLEGE - TRIO STUDENT SUCCESS SERVICES PROGRAM
As a federally funded TRIO program, TRIO-SSS is required to provide documentation of your eligibility for our program to the U.S. Department
of Education in order to meet TRIO regulations that two-thirds of the students in our program meet federal low-income guidelines.
NAME___________________________________________________ SID
You must complete this form, whether or not you believe you qualify as low.-income.
Verification requirements vary depending on whether you are DEPENDENT or INDEPENDENT,
according to federal criteria which is available on the FAFSA website www.fafsa.gov .
Information for the most recent tax year:
I was an Independent Student (typically age 24+, married, emancipated minor, veteran, or parent
providing over half of child(ren)’s support). Complete and sign Part A.
OR I was a Dependent Student (younger than 24, unmarried); parent information is reported on
FAFSA. Your parent/guardian must complete and sign Part B.
Par
t A – Independent Student
Part B – Parent/Guardian
Dependent Students Only
Total Number of Exemptions*
_____________
Or Number of People in Household
Total Number of Exemptions*
_______________
Or Number of People in Household
Taxable Income $______________
(IRS Form 1040- line 43, 1040A line 27, or 1040EZ line 6)
or I did not file a tax return last year
because income was less than required to file.
Taxable Income $______________
(IRS Form 1040- line 43, 1040A line 27, or 1040EZ line 6)
or I/we did not file a tax return last year
because income was less than required to file.
__________________________________________________________
Student Name – please print
___
_______________________________________________________
Student Signature
___
____________________________
Date
__________________________________________________________
Parent/Guardian Name – please print
_____________________________________________________________
Parent/Guardian Signature
___
______________________________
Date
*For IRS Form 1040 and 1040A – use line 6D. For IRS Form 1040EZ, if box on line 5 is unchecked, enter 1 for unmarried and 2 for
married; if box on line 5 is checked, use 1040EZ worksheet line F.
This information will be used only to determine or verify eligibility for the TRIO Student Success Services program at South Seattle College. All
information is confidential and is never passed on to any other agency. The U.S. Department of Education provides more information
Federal TRIO Programs
Current-Year Low-Income Levels
(Effective January 11, 2019 until further notice)
Size of Family Unit
48 Contiguous States, D.C., and Outlying
Jurisdictions
Alaska
Hawaii
1
$18,735
$23,400
$21,570
2
$25,365
$31,695
$29,190
3
$31,995
$39,990
$36,810
4
$38,625
$48,285
$44,430
5
$45,255
$56,580
$52,050
6
$51,885
$64,875
$59,670
7
$58,515
$73,170
$67,290
8
$65,145
$81,465
$74,910
For family units with more than eight members, add the following amount for each additional family member: $6,630
for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $8,295 for Alaska; and $7,620 for
Hawaii.
The term "low-income individual" means an individual whose family's taxable income for the preceding year did not
exceed 150 percent of the poverty level amount.
The figures shown under family income represent amounts equal to 150 percent of the family income levels
established by the Census Bureau for determining poverty status. The 2019 poverty guidelines are in effect as of
January 11, 2019. Federal Register notice forthcoming. Publication is delayed due to temporary closure of federal
offices.
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INCOME VERIFICATION GREEN RIVER COLLEGE - TRIO STUDENT (Green River Community College)

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Completed 27 July 2020

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