Verification of 2017 Income
Information / Individual’s
Unusual Circumstances
Please Type or Print clearly in BLUE or BLACK ink
Federal Student Aid Programs: Your application was selected for review in a process called “Verification.” In this process, the Office of
Financial Aid will be comparing information from your application with your (and your parent(s), if a dependent student or your spouse, if an
independent student) financial documents. We are required to review your FAFSA information under financial aid program rules (34 CFR, Part
668). The law states we have the right to ask you for this information before awarding Federal Aid. If there are differences between your application
information and your financial documents, corrections to your FAFSA may be required.
Student Information
______________________________________________________ ________________________________
Student’s Last Name Student’s First Name Student’s M.I. Southern Crescent Student ID #
____________________________________________________________
Student’s Street Address (include apt. no.) Student’s Date of Birth
____________________________________________________________
City State Zip Code Student’s Email Address
____________________________________________________________
Student’s Home Phone Number (include area code) Student’s Alternate or Cell Phone Number
Please check the Unusual Circumstance that applies to you and submit all listed documents.
_____Individuals Granted a Filing Extension by the IRS
If an individual is required to file a 2017 IRS income tax return and has been granted a filing extension by the
IRS, provide the following documents:
A copy of IRS Form 4868, ‘‘Application for Automatic Extension of Time to File U.S. Individual Income
Tax Return,’’ that was filed with the IRS for tax year 2017;
A copy of the IRS's approval of an extension beyond the automatic six-month extension if the individual
requested an additional extension of the filing time for tax year 2017; and
A copy of IRS Form W–2 for each source of employment income received for tax year 2017 and, if self-
employed, a signed statement certifying the amount of the individual’s Adjusted Gross Income (AGI) and the
U.S. income tax paid for tax year 2017.
Office of Financial Aid
501 Varsity Road 1533 Hwy 19 South
Griffin, GA 30223 Thomaston, GA 30286
770-228-7368 p 706-646-6386 p
770-229-3029 f 706-646-6063 f
