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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U.S.A. forms for Green River Community College

BROWSE GREEN RIVER COMMUNITY COLLEGE FORMS

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G:\TRIO\Forms and Tools\APPLICATION AND INTAKE FORMS\Income Verification\Income Verification.docx
Updated 10/01/2020
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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.
Part 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
marrie
d; 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
I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge.
The U.S. Department of Education funds two TRIO Student Support Services grants in the amounts of $348,002 (SSS) and $261,888 (SSS-STEM)
per year.
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The U.S. Department of Education funds two TRIO Student Support Services grants in the amounts of
$348,002 (SSS) and $261,888 (SSS-STEM) per year.
Federal TRIO Programs
Current-Year Low-Income Levels
(Effective January 15, 2020 until further notice)
Size of Family Unit 48 Contiguous States, D.C., and Outlying Jurisdictions Alaska Hawaii
1 $19,140 $23,925 $22,020
2 $25,860 $32,325 $29,745
3 $32,580 $40,725 $37,470
4 $39,300 $49,125 $45,195
5 $46,020 $57,525 $52,920
6 $52,740 $65,925 $60,645
7 $59,460 $74,325 $68,370
8 $66,180 $82,725 $76,095
For family units with more than eight members, add the following amount for each additional family
member: $6,720 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $8,400 for
Alaska; and $7,725 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 2020 poverty guidelines are in effect as
of January 15, 2020. Federal Register notice was published January 17, 2020
TRIO Home: https://www2.ed.gov/about/offices/list/ope/trio/index.html
Prior-Year Low-Income Levels: https://www2.ed.gov/about/offices/list/ope/trio/low-income-prior.html
NEW 2020 Income Guidelines: https://www2.ed.gov/about/offices/list/ope/trio/incomelevels.html
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INCOME VERIFICATION GREEN RIVER COLLEGE - TRIO STUDENT (Green River Community College)

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Completed 4 February 2021

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