Fillable INDEPENDENT VERIFICATION WORKSHEET (V5) (Grand Canyon University)

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INDEPENDENT VERIFICATION WORKSHEET (V5) (Grand Canyon University)

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Page 1 of 5
INDEPENDENT VERIFICATION WORKSHEET (V5)
2021 – 2022
AGGREGATE VERIFICATION
Your application for financial aid was selected for review in a process called “Verification”. Please submit the documentation as soon as
possible but no later than 120 days after your last day of enrollment, or by September 2022, whichever occurs first. No funds will be
disbursed until the verification process is completed. Failure to complete the verification process by the deadline will result in your
ineligibility for Title IV funds for the award year. The law states we have the right to ask you for this information before awarding any
federal aid. If there are differences between the information supplied on your federal application and your financial documents, we will
need to correct this information. We must review the required information under the financial aid program rules (34 CFR, Part 668).
The Departm ent of Education has requested that the institution verify certain item s for a student selected for this review. All
verification items listed on this worksheet must be verified to determine Title IV eligibility.
To review the status of your awards, please visit your Student Portal at http://gcuportal.gcu.edu/.
A. Student Information
STUDENT NAME: ____________________________________________
Address: __________________________________________________
City: _______________________ ______ ______________
State: Zip:
GCU STUDENT NUMBER: _______________________________
Date of Birth: ________________________________________
Phone No.: __________________________________________
B. Family Information
List the people in your household. Include:
Full Name Age Relationship Full Name of College (No Acronyms)*
Self Grand Canyon University
*Household members must be enrolled at least half time as a ‘regular’ student in a degree/certificate granting program between July 1, 2021 and
June 30, 2022.
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• Yourself
• Your spouse (if married)
• Your children, if any, if you will provide more than half of their support from July 1, 2021, through June 30, 2022, even if they
do not live with you. If your child is between the ages of birth and one year, please list the age as "1"
• Any unborn child who is scheduled to be born between July 1, 2021 through June 30, 2022 should be listed with an age of "0" with
the relationship noted as "unborn child"
• Other people if they lived with you and received more than half their support from you and will continue to receive more than
half their support from you through June 30, 2022
BACHELOR PROGRAM: All fields and sections are required to be completed.
MASTERS/DOCTORAL PROGRAM: Only sections A, E, and G are required to be completed. The remaining sections may be left blank.
** Your tax information will not be necessary if you and/or your spouse were able to retrieve your tax information using the IRS Data
Retrieval Tool when completing the 2021-2022 FAFSA and no changes were made after the information was retrieved.
Page 2 of 5
STUDENT NAME: GCU STUDENT NUMBER: _______________________________
_
C. Source of Income – Student: COMPLETE EITHER SECTION 1 OR SECTION 2
Instructions: The best way to verify income is by using the IRS Data Retrieval Tool that is part of FAFSA on the Web. If you have not already used
the tool, go to FAFSA.gov, log into your FAFSA record, select “Make FAFSA Corrections,” and navigate to the Financial Information section of the
form. From there, follow the instructions to determine if you are eligible to use the IRS Data Retrieval Tool to transfer 2019 IRS income tax
information into your FAFSA.
1. Student: Tax Filer
Check the box that applies:
I have used the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer 2019 IRS income information into my 2021-2022 FAFSA,
either on the initial FAFSA or when making a correction to the FAFSA. GCU will use the IRS information that was transferred for the
verification process.
I am unable or choose not to use the IRS Data Retrieval Tool in FAFSA on the Web, and will submit to the school a 2019 IRS Tax Return
Transcript or, if I'm unable to obtain a transcript, a signed paper copy of the 2019 IRS tax return that was submitted to the IRS. You
mayfind the transcript at https://www.irs.gov/individuals/get-transcript and then click “Get Transcript Online.” You must have access to
avalid email address, a text-enabled mobile phone in your name, and specific financial account numbers (such as a credit card number
oran account number for a home mortgage or auto loan). Make sure to request the “Return Transcript” and not the
“Account Transcript." If "Get Transcript Online" is not available, click on "Get Transcript by Mail" or call 1-800-908-9946.
Check here if your IRS Tax Return Transcript(s) or signed tax return(s) is attached to this worksheet.
Check here if your IRS Tax Return Transcript(s) or signed tax return(s) will be submitted to GCU later. Verification
cannot be completed until the IRS Tax Return Transcript(s) or signed tax return(s) has been submitted to GCU.
2.
I was not employed, had no income earned from work in 2019, and was not required to file a tax return; OR
I was employed in 2019 but was not required to file a tax return. Listed below are the names of all my employers and the amount
earned from each employer in 2019. W-2s are required from all employers.
DO NOT leave the section below blank if employed. Enter “none” if you did not earn income in 2019 or enter the amount of income earned
during 2019.
Student’s Source of Income
2019 Amount
W-2 Attached? If not, why?
$
$
$
$
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Student: Non-Tax Filer Complete this section if C.1 above did not apply and you will not file and were not required to file a 2019
income tax return with the IRS. You must also submit an IRS "Verification of Non-filing Letter" (VONF) dated on or after 10/1/2020 for tax
year 2019 whether or not you were employed. You may find the form at https://www.irs.gov/individuals/get-transcript and then click "Get
Transcript Online". You must have access to a valid email address, a text-enabled mobile phone in your name, and specific financial account
numbers (such as a credit card number or an account number for a home or auto loan). Make sure to request the "Verification of Non-filing
Letter", and in the Tax Year field, select "2019". If "Get Transcripts Online" is not available, click on "Get Transcripts by Mail" or call
1-800-908-9946. If you are unable to obtain a VONF, please contact your GCU Counselor to complete a "Statement of Non-filing" form.
Page 3 of 5
STUDENT NAME: GCU STUDENT NUMBER: ________________________________
2.
I was not employed, had no income earned from work in 2019, and was not required to file a tax return; OR
I was employed in 2019 but was not required to file a tax return. Listed below are the names of all my employers and the amount
earned from each employer in 2019. W-2s are required from all employers.
DO NOT leave the section below blank if employed. Enter “none” if you did not earn income in 2019 or enter the amount of income earned
during 2019.
Spouse’s Source of Income
2019 Amount
W-2 Attached? If not, why?
$
$
$
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D. Source of Income – Spouse: COMPLETE EITHER SECTION 1 OR SECTION 2 IF APPLICABLE
1.
Spouse: Tax Filer
Check the box that applies:
I have used the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer 2019 IRS income information into my 2021-2022 FAFSA,
either on the initial FAFSA or when m aking a correction to the FAFSA. GCU will use the IRS information that was transferred for the
verification process.
I am unable or choose not to use the IRS Data Retrieval Tool in FAFSA on the Web, and will submit to the school a 2019 IRS Tax Return
Transcript or, if I'm unable to obtain a transcript, a signed paper copy of the 2019 IRS tax return that was submitted to the IRS. You may find the
transcript at https://www.irs.gov/individuals/get-transcript and then click “Get Transcript Online.” You must have access to a valid email
address, a text-enabled mobile phone in your name, and specific financial account numbers (such as a credit card number or an account
number for a home mortgage or auto loan). Make sure to request the “Return Transcript” and not the
“Account Transcript." If "Get Transcript Online" is not available, click on "Get Transcript by Mail" or call 1-800-908-9946.
Check here if your IRS Tax Return Transcript(s) or signed tax return(s) is attached to this worksheet.
Check here if your IRS Tax Return Transcript(s) or signed tax return(s) will be submitted to GCU later. Verification
cannot be completed until the IRS Tax Return Transcript(s) or signed tax return(s) has been submitted to GCU.
Spouse: Non-Tax Filer Complete this section if D.1 above did not apply and you will not file and were not required to file a 2019
income tax return with the IRS. You must also submit an IRS "Verification of Non-filing Letter" (VONF) dated on or after 10/1/2020 for tax
year 2019 whether or not you were employed. You may find the form at https://www.irs.gov/individuals/get-transcript and then click
"Get Transcript Online". You must have access to a valid email address, a text-enabled mobile phone in your name, and specific financial
account numbers (such as a credit card number or an account number for a home or auto loan). Make sure to request the "Verification of
Non-filing Letter", and in the Tax Year field, select "2019". If "Get Transcripts Online" is not available, click on "Get Transcripts by Mail" or
call 1-800-908-9946. If you are unable to obtain a VONF, please contact your GCU Counselor to complete a "Statement of Non-filing" form.
Page 4 of 5
Notary’s Certificate of Acknowledgement
State of ________________________________ City/County of _____________________________________
On _______________________________, before me, _____________________________________________,
(Date) (Notary’s Name)
personally appeared, _____________________________________ and provided to me on basis of satisfactory
(Printed Name of Signer)
evidence of identification __________________________________ to be the above-named person who signed
(Type of government-issued photo ID)
the foregoing instrument.
WITNESS my hand and official seal ___________________________________________
(seal) (Notary Signature)
My commission expires on _____________________
(Date)
STUDENT NAME: GCU STUDENT NUMBER: ________________________
E. Proof of Identity/Statement of Educational Purpose: COMPLETE EITHER SECTION 1 OR SECTION 2
1. To be Signed in the Presence of a Grand Canyon University Official
A. The student must appear in person at GCU to verify his or her identity by presenting an unexpired valid government-issued
photo identification (ID), such as, but not limited to, a driver's license, other state-issued ID, or passport. The institution will
maintain a copy of the student's photo ID that is annotated by the institution with the date it was received and reviewed,
and the name of the official at the institution authorized to receive and review the student's ID.
B. In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose below.
Statement of Educational Purpose
I certify that I _____________________________________________ (Print Student Name) am the individual signing this
Statement of Educational Purpose and that the Federal student financial assistance I may receive will only be used
for educational purposes and to pay for the cost of attending Grand Canyon University for 2021 - 2022.
Student Signature: ______________________________________
Date: ___________________________
2. To be Signed in the Presence of a Notary
If the student is unable to appear in person at GCU to verify his or her identity, the student must provide to the institution the
following via mail to the address listed at the bottom of this page:
A. A copy of the unexpired valid government-issued photo ID that is acknowledged in the notary statement below, or that is
presented to a notary, such as, but not limited to, a driver's license, other state-issued ID, or passport; and
B. The original Statement of Educational Purpose provided below, which must be notarized. If the notary statement
appears on a separate page than the Statement of Educational Purpose, there must be a clear indication that the
Statement of Educational Purpose was the document notarized.
Statement of Educational Purpose
I certify that I _____________________________________________ (Print Student Name) am the individual signing this
Statement of Educational Purpose and that the Federal student financial assistance I may receive will only be used
for educational purposes and to pay for the cost of attending Grand Canyon University for 2021 - 2022.
Student Signature: ______________________________________
Date: ___________________________
California Notaries: Using the separate CA notary form is
acceptable as long as the type of photo ID presented is
noted on the form.
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Mail this document and a copy of the photo ID presented to
the Notary (e.g. driver's license) to: Grand Canyon
University, Office of Financial Aid, P.O. Box 11549, Phoenix,
AZ 85061
Page 5 of 5
STUDENT NAME: GCU STUDENT NUMBER: ________________________
F. High School Completion Status
For the 2021-2022 award year, we are required by the Department of Education to verify your high school completion status. As this is
documentation already required for admission into Grand Canyon University, our office will work with the Office of Academic Records to
determine if you have submitted the appropriate document(s) to confirm your high school completion status.
If additional information is required, you will be contacted by your GCU Student Services Counselor and asked to provide a copy of your
high school diploma, high school transcripts indicating a graduation date, copy of a GED, etc.
G. Certification and Signature (Handwritten Signature Required – Typed/Electronic Signature Not Accepted)
By signing below the student certifies that all of the information reported is complete and correct.
Student Signature: __________________________________________Date: _______________________________
WARNING: If false or misleading information is purposely given on this worksheet, student may be fined, sent to prison, or both
P0109082020
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INDEPENDENT VERIFICATION WORKSHEET (V5) (Grand Canyon University)

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Completed 28 January 2021

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