FA-25 / 18-19 REV Page 3 of 3
2018-2019 Verification Worksheet
Independent - Standard Verification Group (V1)
PLEASE RETURN THIS FORM TO THE CSU CHANNEL ISLANDS FINANCIAL AID & SCHOLARSHIPS OFFICE
One University Drive, Camarillo, California 93012-8599 financial.aid@csuci.edu www.csuci.edu/financialaid Tel: (805) 437-8530
C. Spouse’s Income Information (Complete if Married/Remarried)
Did, or will, your spouse file a 2016 income tax return with the IRS?
Yes (select one option from column below)
No (select one option from column below)
My spouse has used the IRS Data Retrieval Tool (IRS DRT)
My spouse was not employed and had no income earned from
work in 2016
Submit your spouse’s Verification of Non-filing for 2016*
My spouse is unable or chooses not to use the IRS DRT
Submit a signed copy of your spouse’s 2016 1040 Tax
Return or a copy of their 2016 IRS Tax Return Transcript*
My spouse was employed in 2016
Submit your spouse’s Verification of Non-filing for 2016*
Submit a copy of all your spouse’s 2016 Form W-2(s) from
their employers or your spouse’s 2016 IRS Wage and
Income Transcripts*
List the names of all your spouse’s employer(s) and the
amount earned from each employer in 2016
My spouse will file, but they have not yet completed their
return because they have been approved for an extension
beyond the October 2017 deadline
Submit your spouse’s Verification of Non-filing for 2016*
Submit a copy of your spouse’s 2016 IRS Form 4868
Submit a copy of a letter from the IRS confirming your
spouse was approved for an extension beyond six months
Submit a copy of all your spouse’s 2016 Form W-2(s) from
their employers or your spouse’s 2016 IRS Wage and
Income Transcripts*
If your spouse was self-employed, submit a typed and signed
statement (use the "Financial Aid Statement Form") with the
amount of their 2016 Adjusted Gross Income (AGI) and
estimated U.S. income taxes paid
Example:
Alfred’s Auto Body Shop
If you are unable to provide the documents please contact our
office for further instruction.
* For further instruction, refer to the IRS Tax Transcript Information sheet found on our website at www.csuci.edu/financialaid/financial-aid-forms
D. Untaxed Income Information
1. In 2016, did you or your spouse have any untaxed portions of an IRA
Distribution(s) that was a rollover?
2. In 2016, did you or your spouse have any untaxed portions of a
Pension(s) Distribution(s) that was a rollover?
Yes… Total rollover amount for 2016: $
Yes … Total rollover amount for 2016: $
E. Certification and Signature
The student must sign and date below. If married, the spouse's signature is optional. Each person signing this worksheet certifies that all of the
information reported on this form is true and accurate to the best of their knowledge.
WARNING:
If you purposely give false or
misleading information on this
form, you may be fined, sentenced
to jail, or both.
Student’s Signature (electronic signatures not accepted)
Spouse’s Signature (electronic signatures not accepted)
