Fill out either Part II or Part III:
City, State, and Zip Code:
245 NE 30 Rd
Great Bend KS 67530
Request for Student's Taxpayer Identification Number
(Substitute Form W-9S)
Name of Student:
Part I
Do not submit this form
to the IRS.
Instructions: All students must fill out Part I of this form. If you have a SSN or ITIN, fill out Part II. If you do not have a SSN or ITIN, or do
not wish to provide the information, fill out Part III. Please email this form to VSN@bartonccc.edu
Barton ID:
A
ddress (number, street, and apt. or suite no.):
Taxpayer Identification Number (SSN or ITIN):
Purpose: Barton Community College is required to collect your correct identifying number to file Form 1098-T, Tuition Statement, with the IRS and to furnish
a statement to you. This will be your Social Security number (SSN) or, if you are not eligible to obtain an SSN, your individual taxpayer identification number
(ITIN). Form 1098-T contains information about qualified tuition and related expenses to help determine whether you, or the person who can claim you as a
dependent, may take either the tuition and fees deduction or claim an education credit to reduce Federal income tax. For more information, see IRS Pub. 970,
Tax Benefits for Higher Education. Under federal law, you are required to provide the requested information.
Part I.
Enter your name and mailing address. The name should match that used by the Social Security Administration or Internal Revenue Service. Enter your Barton
student identification number.
Part II.
Taxpayer identification number: Enter your SSN or ITIN. If you do not have an SSN or ITIN, apply for one and fill out and return this form when you receive it.
Sign your name in the space provided to confirm the information provided. The registrar's office cannot change your records without your signature.
Part III.
Please fill out this part only if you are unwilling or unable to provide a taxpayer identification number. Check either the first or second box and sign the
statement. By law, Barton Community College must ask you at least once a year for your taxpayer identification number in order to meet its obligation to file
Form 1098-T.
Penalties
If you fail to furnish your correct SSN or ITIN to Barton Community College, the IRS may impose a penalty of $100 unless your failure is due to reasonable
cause and not to willful neglect or misuse of SSNs. If Barton Community College discloses or uses your SSN in violation of Federal law, Barton Community
College may be subject to civil and criminal penalties.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to give your correct SSN or ITIN to persons who must file information returns with the IRS to report
certain information. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this
information to the Department of Justice for civil and criminal litigation and to cities and states to carry out their tax laws.
_________________________________________
I certify that the number shown on this form is my correct taxpayer identification number.
_________________________
Part II
Part III
I am a foreign national/nonresident alien and do not have a Social Security number or individual taxpayer identification
number. I do not plan to file an income tax return in the U.S.
I do not wish to provide my taxpayer identification number to Barton Community College at this time. I understand that
I may be subject to an IRS fine of $100 for failure to do so. I further understand that the IRS will not be able to use the Form
1098-T filed by Barton Community College to confirm my eligibility for certain education tax benefits without my taxpayer
identification number.
_________________________
_________________________________________
