Fillable QC15STCF MODESTO JUNIOR COLLEGE

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QC15STCF MODESTO JUNIOR COLLEGE

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STUDENT FINANCIAL SERVICES
2015-2016 Verification of Student Marital Status Conflict
Student’s Name
Student ID#
The marital status you reported on the FAFSA does not appear to agree with the tax return filing status reported on
the FAFSA. Complete this form and submit it to Student Financial Aid Services as soon as possible so that your
financial aid application can be processed.
TO BE COMPLETED BY STUDENT:
What was your tax filing status on your 2014 Tax Return? (Please select one)
Single
Head of Household
Married Filing Jointly
Married Filing Separately
Qualifying Widow with Dependent
At the time that you completed the FAFSA, what was your marital status? (Please select one)
Never Married
Married/Remarried
Divorced
Separated
Widowed
If your marital status changed AFTER you filed taxes, please include the date that it changed.______________
MM/YY
Please use the following space for further clarification _____________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Please check the appropriate box below:
I have reviewed the income reported on my FAFSA and it correctly reflects all 2014 income.
The income reported on my FAFSA is incorrect and a correction was submitted on __________________.
I certify that the information provided is true and complete. I understand that this information will be used to determine the student’s
eligibility for financial aid and that false or misleading information may be the cause for termination of aid and repayment of funds
received. I also understand that purposely reporting false or misleading information may result in fines or imprisonment or both.
___________________ _________________________________
Student’s Signature Date
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QC15STCF MODESTO JUNIOR COLLEGE

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Completed 28 March 2020

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