Independent Student Verification Worksheet 2020-2021
Your2020‐2021FreeApplicationforFederalStudentAid(FAFSA)wasselectedforreviewinaprocesscalledverification.
ThelawstatesthatbeforeawardingFederalStudentAid,wemayaskyoutoconfirmtheinformationyoureportedonyour
FAFSA.Toverifythatyouprovidedcorrectinformation,wewillcompareyourFAFSAwiththeinformationonthis
institutionalverificationdocumentalongwithanyotherrequireddocuments.Iftherearediscrepancies,yourFAFSA
informationmayneedtobecorrected.Youandyourspouse(ifapplicable)mustcompleteandsignthisinstitutional
verificationdocument,attachanyrequireddocuments,andsubmittheformandotherrequireddocumentstous.Wemay
askforadditionalinformation.Ifyouhavequestionsaboutverification,pleasecontactussothatyourfinancialaidwillnot
bedelayed.
ReturnthisformtoFinancialAidvia:Fax203‐582‐4511ormail.
Section1–StudentInformation

Student’sLastName Student’sFirstName Student’sM.I. Student’sQUID

Student’sStreetAddress(includeapt.no.)  Student’sDateofBirth

City State ZipCode Student’sEmailAddress

Student’sHomePhoneNumber(includeareacode)  Student’sAlternateorCellPhoneNumber
Section2–HouseholdInformation‐ListbelowthepeopleinyourhouseholdwhomyouareprovidingMORETHAN½of
theirSUPPORT.Include:
Youandyourspouse,ifmarried.
Youorspouse’schildren,ifyouoryourspousewillprovidemorethanhalfoftheirsupportfromJuly1,2020,through
June30,2021,evenifthechildrendonotlivewithyou.
Otherpeopleiftheynowlivewithyou,andyouoryourspouseprovidesmorethanhalfoftheirsupportandwillcontinue
toprovidemorethanhalfoftheirsupportthroughJune30,2021.
Foranyhouseholdmemberwhowillbeenrolledatleastpart‐timeinadegree,diploma,orcertificateprogramataneligible
postsecondaryeducationalinstitutionanytimebetweenJuly1,2020,andJune30,2021,includethenameofthecollege.
Ifmorespaceisneeded,provideaseparatepagewithyournameandIDnumberatthetop.
FullName Age Relationship College
WillbeEnrolledat
LeastPart‐Time
(YesorNo)
Self QuinnipiacSOM



Note:Wemayrequireadditionaldocumentationifwehavereasontobelievethattheinformationregardingthehouseholdmembers
enrolledineligiblepostsecondaryeducationalinstitutionsisinaccurate.
StudentName:_______________________________________________________________StudentID:_________________________
OfficeofFinancialAid,275MountCarmelAvenue,NH‐MED,Hamden,CT06518
Fax(203)582‐4511 Phone(203)582‐5100 Email:finaidmedicine@qu.edu
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Section3–Income/TaxInformation–IfFiledorWillFilea2018TaxReturn
ImportantNote:Theinstructionsbelowapplytoyouandyourspouse,ifyouaremarried.Notifythefinancialaidofficeifyouoryour
spousefiledseparateIRSincometaxreturnsfor2018orhadachangeinmaritalstatusafterDecember31,2018.
Instructions:Completethissectionifyouandyourspousefiledorwillfilea2018IRSincometaxreturn(s).Thebestwaytoverifyincome
isbyusingtheIRSDataRetrievalTool(IRSDRT)thatispartofFAFSA.Inmostcases,nofurtherdocumentationisneededtoverify2018
IRSincomeinformationthatwastransferredintoyourFAFSAusingtheIRSDRTifthatinformationwasnotchangedbytheFAFSAfiler.
Inmostcases,forelectronictaxreturnfilers,2018IRSincometaxreturninformationisavailablefortheIRSDRTortheIRSTaxReturn
Transcriptwithin2–3weeksafterthe2018electronicIRSincometaxreturnhasbeenacceptedbytheIRS.Generally,forfilersof2018
paperIRSincometaxreturns,the2018IRSincometaxreturninformationisavailablefortheIRSDRTortheIRSTaxReturnTranscript
within6–8weeksafterthe2018paperIRSincometaxreturnhasbeenreceivedbytheIRS.Contactthefinancialaidofficeifmore
informationisneededaboutusingtheIRSDRTorobtaininganIRSTaxReturnTranscript.
Checktheboxthatapplies:
IhaveusedtheIRSDRTfromtheFAFSAontheWebtotransfer2018IRSincometaxreturninformationintomyFAFSA.
IhavenotyetusedtheIRSDRTfromtheFAFSAontheWeb,butwillusethetooltotransfer2018IRSincometaxreturn
informationintomyFAFSA.
IamunabletoorchoosenottousetheIRSDRTfromtheFAFSAontheWeb,andinsteadwillprovidetheschoola2018IRSTax
ReturnTranscript(s).
A2018IRSTaxReturnTranscriptmaybeobtainedthrough:
GetTranscriptbyMAIL–Gotowww.irs.gov,undertheToolsheading,click"Getyourtaxrecord.”Click“GetTranscriptby
MAIL.”Makesuretorequestthe“IRSTaxReturnTranscript”andNOTthe“IRSTaxAccountTranscript.”
GetTranscriptONLINE–Gotowww.irs.gov,undertheToolsheading,click"Getyourtaxrecord"Click“GetTranscript
ONLINE.”Makesuretorequestthe“IRSTaxReturnTranscript”andNOTthe“IRSTaxAccountTranscript.”
AutomatedTelephoneRequest–1‐800‐908‐9946
PaperRequestForm–IRSForm4506T‐EZorIRSForm4506‐T
Ifyouandyourspousefiledseparate2018IRSincometaxreturns,theIRSDRTcannotbeusedandthe2018IRSTaxReturn
Transcript(s)mustbeprovidedforeach.
____Checkhereifa2018IRSTaxReturnTranscript(s)isprovided.
____Checkhereifa2018IRSTaxReturnTranscript(s)willbeprovidedlater.
Certification and Signature(s) – please print and sign
Eachpersonsigningbelowcertifiesthatalloftheinformationreportediscompleteandcorrect.
____________________________________________________________ ___
StudentsSignature(Required)Date
___________________________________________________________ ___
SpousesSignature(Optional)Date
WARNING: If you purposely give false or
misleading information you may be fined,
sentenced to prison, or both.
click to sign
signature
click to edit
click to sign
signature
click to edit
StudentName:_______________________________________________________________StudentID:_________________________
OfficeofFinancialAid,275MountCarmelAvenue,NH‐MED,Hamden,CT06518
Fax(203)582‐4511 Phone(203)582‐5100 Email:finaidmedicine@qu.edu
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
Ifyouandyourspousefileda2018taxreturn,youdonotneedtocompletethisform.
Section4–Verificationof2018IncomeInformationforStudentNon‐taxFilers
Theinstructionsandcertificationsbelowapplytoyouandyourspouse,ifthestudentismarried.Completethissectionif
theyouandyourspousewillnotfileandarenotrequiredtofilea2018incometaxreturnwiththeIRS.
Checktheboxthatapplies:
MyspouseandIwerenotemployedandhadnoincomeearnedfromworkin2018.
Iwasemployedin2018and/ormyspousewasemployedin2018andhavelistedbelowthenamesofallemployers,
theamountearnedfromeachemployerin2018,andwhetheranIRSW‐2formisprovided.[Providecopiesofall
2018IRSW‐2formsissuedtoyouandyourspousebyyouremployers].Listeveryemployereveniftheemployerdid
notissueanIRSW‐2form.
Ifmorespaceisneeded,provideaseparatepagewiththestudent’snameandIDnumberatthetop.
Employer’sName IRSW‐2
Provided?
AnnualAmount
Earnedin2016
AB
C
’sAutoBodyShop(example) Yes $4,50
0
TotalAmountofIncomeEarnedfromWor
k
$
ProvidedocumentationfromtheIRS(VerificationofNon‐filerletter)orotherrelevanttaxauthoritydatedonorafter
October1,2019thatindicatesa2018IRSincometaxreturnwasnotfiledwiththeIRSorotherrelevanttaxauthority.
Youcanobtaina“VerificationofNon‐filer”letterfromtheIRSbysubmittingIRSForm4506‐Tandcheckingbox7.
____Checkhereifconfirmationofnon‐filingisprovided.
____Checkhereifconfirmationofnon‐filingwillbeprovidedlater.
Certification and Signature – please print and sign
Eachpersonsigningbelowcertifiesthatalloftheinformationreportediscompleteandcorrect.
________________________________________ ________________________
StudentsSignature(Required)Date
___________________________________________________________ _
SpousesSignature(Optional)Date
WARNING: If you purposely give false or
misleading information you may be fined,
sentenced to jail, or both.
click to sign
signature
click to edit
click to sign
signature
click to edit
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