Office of Financial Aid and Scholarships
Secure submission of documents can be completed in person, by mail, or fax to:
Office of Financial Aid and Scholarships · Roger Rook Hall · 19600 Molalla Avenue, Oregon City, OR 97045
Phone: 503-594-6082 · Fax: 503-722-5864 · e-mail: finaid@clackamas.edu · www.clackamas.edu
03/02/20 Dp
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2020-2021 Independent
V1 Standard Verification Worksheet
FAC20V1I
Your FAFSA application has been selected for a process called verification. Please complete all parts of this worksheet and return to the Financial Aid
Office. Notice: incomplete forms may delay processing.
B. Household InformationList the members in your household. Attach an additional sheet if necessary.
Please include: yourself and your spouse (if legally married), your children/step-children, if you will provide more than half of their support between
July 1, 2019 and June 30, 2020, even if they do not live with you, and other people if they now live with you and you provide more than half of their
support and you will continue to provide more than half of their support between July 1, 2020 and June 30, 2021.
Full Name
Relationship to
Student
Age
Enrolled in College
at least half-time
(check one)
Self
Yes
No
Spouse
Yes
No
Child/other:
Yes
No
Child/other:
Yes
No
Child/other:
Yes
No
Child/other:
Yes
No
C. Federal Tax Return Filing Status Student (and Spouse, if married). Please select the appropriate response.
I filed my 2018 return and successfully used the IRS Data Retrieval Tool via the FAFSA. Tax transcript not required.
I filed my 2018 return and chose not to or, I am unable to use the IRS Data Retrieval Tool. Submit: Copy of 2018 (signed)
Tax Return and Schedules 1, 2 & 3 or Tax Return Transcript. If married and you and your spouse filed separate 2018 Income
Tax Returns, submit: Copy of 2018 (signed) Tax Returns and Schedules 1, 2 & 3 or Tax Return Transcripts for both you
and your spouse.
I amended my taxes after originally filing my 2018 return and will submit:
o Copy of 2018 (signed) Tax Return, and Schedules 1, 2 & 3 or Tax Return Transcript
o 2018 (signed) IRS 1040X form
o If married and you filed separate 2018 Income Tax Returns, you must submit signed copies of Tax Returns and
Schedules 1, 2 & 3 or Tax Return Transcripts and Signed IRS 1040X form for both you and your spouse.
I will not and am not required to file a federal tax return. I was not employed and earned no income from work in 2018.
Submit: 2018 IRS Verification of Non-filing Letter
I will not and am not required to file a federal tax return. The source(s) and amounts of income are listed below:
Submit: 2018 IRS Verification of Non-filing Letter
Employer’s Name
2018 Earned
Amount
IRS W-2/1099 Attached
Yes
No
Yes
No
Yes
No
Yes
No
*IRS Verification of Non-Filing Letters can be requested by checking box 7 and 8 (if no W-2s provided) on IRS Form 4506-T. Notice: 2018 IRS Verification of Non-
Filing Letters must be dated on or after October 1, 2018.
D. Certification and Signatures Each person signing this worksheet certifies that all of the information reported on it is complete
and correct. The student whose information was reported on the FAFSA must sign and date. Warning! If you purposely give false or
misleading information you may be fined, sentenced to jail, or both.
Student Signature: _____________________________________________________ Date____________________
Spouse Signature: ______________________________________________________ Date____________________
(optional)
This worksheet must be signed and dated to be valid. Electronic and/or digital signatures are not valid.
A. Student Information
Student’s Name: ________________________________________________ CCC ID: ___________________
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