1516_VERV1_TRACKING REQUIREMENT_S
Office of Student Financial Aid Lamar State College Port Arthur
MEMBER THE TEXAS STATE UNIVERSITY SYSTEM
TM
2019-2020 VERIFICATION WORKSHEET
P00
Last Name First Name M.I. Social Security Number Student ID Number
Your FAFSA was selected by the U.S. Department of Education for a review process called “Verification.” Federal law
states that we have the right to ask for this information. Your application will be considered incomplete until each
section is complete and all required documents and signatures have been received by the LSCPA Financial Aid Office.
If there are differences between your application information and this document, corrections may need to be made to
your Student Aid Report (SAR).
SECTION A: Household Size Information
List all people in the household in the space(s) below. Include the name of the college for any household member,
excluding your parent(s), who will be attending at least half-time between July 1, 2019 and June 30, 2020, and will be
enrolled in a degree, diploma, or certification program. If you need more space, attach a separate page.
DEPENDENT STUDENTS: List names of all persons in your parent(s) household. Include yourself, your parents and their other children
(even if they do not live with your parents) if your parents will provide more than half of their support from July 1, 2019 through June 30,
2020. Also include other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will
continue that support through June 30, 2020.
INDEPENDENT STUDENTS: List names of all persons in your household. Include yourself, your spouse and all children (even if they do
not live with you) if you will provide more than half of their support from July 1, 2019 through June 30, 2020. Also include other people if you
provide MORE THAN HALF of their support and will continue to provide more than half of their support through June 30, 2020.
First Name Last Name
Age
Relationship to you
(Parent, brother/sister, etc.)
If person will attend college half-time or more in 2019-2020
print the name of the college.
SELF
LSCPA
Check this box if there are more than six (6) household members. Attach a list of these people, providing
the same information as requested above
SECTION B: Tax Return Filer Information
Official Tax Return Transcripts are required for verification unless the Data Retrieval Tool (DRT) was used on the
FAFSA. Please complete the following:
Student and Spouse Parent(s)
___ Check here if you used the Data Retrieval Tool. ___ Check here if you used the Data Retrieval Tool.
___ Check here if you are submitting a copy of your ___ Check here if you are submitting a copy of your
2017 IRS Tax Return Transcript. 2017 IRS Tax Return Transcript.
___ Check here if you did not file, will not file, and ___ Check here if you did not file, will not file, and
are not required to file a 2017 Tax Return. are not required to file a 2017 Tax Return.
Section C: Income Information for Nontax Filers
Complete this section if the student and spouse (if married) and parent(s) (if dependent), are not required to file a 2017
Tax Return.
Student and Spouse
____ Check here if the student and spouse were not
employed and had no income earned from work in 2017.
____ Check here if the student and spouse did work but
did not file. Complete the table below, and attach all 2017
W-2’s. If Self-Employed, submit a signed statement
certifying amount of Adjusted Gross Income earned and
Income Tax paid for 2017.
Parent(s)
___ Check here if the parent(s) were not employed and
had no income earned from work in 2017.
___ Check here if the parent(s) did work but did not file.
Complete the table below, and attach all 2017
W-2’s. If Self-Employed, submit a signed statement
certifying amount of Adjusted Gross Income earned and
Income Tax paid for 2017.
Nontax Filers Complete the Table Below:
Employers Name
2017 Parent(s) Wages Earned
SECTION D: Certification and Signature
Lamar State College Port Arthur is an equal opportunity/affirmative action educational institution and employer.
You (spouse’s signature optional) must sign below certifying the accuracy of the information provided on this form. If you were required to
provide parental information, at least one of your parents must also sign below certifying the accuracy of the information provided on this
form.
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
I give permission for corrections to be made to the FAFSA by the LSCPA Financial Aid Office. I (we) certify that all of the information on
this form is completed and correct.
Student’s Signature Date Father’s (Stepfather’s) Signature Date
Spouse’s Signature (Optional) Date Mother’s (Stepmother’s) Signature Date