2021-22 Verification of Non-Filing Statement
Student ID Number:
Student Name
Phone Numbe
Please read carefully. Form must be completed in blue or black ink. Failure to accurately complete this form may
result in a delay of processing or change of financial aid eligibility. Additional documentation may be requested.
Verification of students tax information or non-filing tax status is required to review a students eligibility for federal
student aid. If you have a non-filing status with the Internal Revenue Service (IRS) it is a requirement that the school
collect a Verification of Non-filing letter. If you are unable to obtain the Verification of Non-Filing letter from the
Internal Revenue Service (IRS) you may self-certify by completing this form.
1. I certify that I and/or spouse have not filed and am/are not
(Student’s printed name)
required to file a 2019 federal income tax return.
2. I certify that I and/or spouse have made a good faith effort to
(Student’s printed name)
obtain the Statement of Non Filing from the Internal Revenue Service (IRS), but was unable to.
By signing this
document, I certify that the information completed is true and accurate. I understand that purposely providing
false or misleading information could result in criminal prosecution, prison sentence, and/or a fine pursuant to U.S. Criminal
Code and Colorado Criminal Code.
Student Signature: Date:
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