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Verification of Income for Student Non-Tax Filers 2021-2022
_________________________________________________________ _____________________________________
Student’s Name: Last First M.I. Stony Brook ID#
_________________________________________________________ ______________________________________
Address: (number, street, city, state, zip) Student’s phone number
Complete this section if you and/or your spouse (if married) will not file and *are not required (see table below) to file a 2019 income tax return
with the IRS. Submit this completed and signed form along with all W-2 forms. Student (and spouse if married) must check one box:
Student was not employed, nor had income earned from work in 2019.
Student was employed in 2019. Student did not, and was not required to file a tax return. List below the names of all employers, and the
amount earned in 2019. [Provide copies of all 2019 W-2 forms issued by the employers]. List every employer even if the employer did not issue a
W-2 form.
Spouse (if student is married) was not employed, nor had income earned from work in 2019.
Spouse (if student is married) was employed in 2019. Spouse did not, and was not required to file a tax return. List below the names of
all employers, and the amount earned in 2019. [Provide copies of all 2019 W-2 forms issued by the employers]. List every employer even if the
employer did not issue a W-2 form.
List Name of Employee (Student/Spouse)
Source of income (Employer’s Name)
Annual Amount Earned
in 2019
Total Amount of Income Earned From Work
*If a W-2 not provided for each source of income explain: ________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
You must physically sign this form as typed signatures are not acceptable.
Certification and Authorization: Do NOT submit this form without All required signatures. By signing this form, I certify that all the
information reported is complete and correct.
____________________________________________________ ________ ________________________________________________ ________
Student’s Signature (Required) Date Parent Signature (Required for Dependent Students Only) Date
*2019 Federal Income Tax Filing Requirements
For most people, a tax return must be filed with the IRS if their 2018 income was at least:
This information is from
irs.gov.
Amounts listed are for people
under the age of 65
If you are over 65, please visit
the IRS website.
Self-Employment Income (includes a trade or business as a sole proprietor,
independent contractor, member of partnership, if you are in business for
yourself in any other way)
$400 or more
(net earnings)
Single dependent student (parents or someone
else can claim you as a dependent)
Married, filing separately
Married, filing joint return
Qualifying Widow(er), with
dependent child
For secure and faster processing, submit this form via the Upload Process located in your SOLAR To Do List.
Alternatively, mail or fax all documents to the appropriate financial aid department listed below.
Schools of Nursing, Social Welfare, Health Technology and Management, and
the Graduate Programs in Public Health and Nutrition:
All Other Graduate and Undergraduate Programs
Health Sciences Office of Student Services
Health Sciences Tower Level 2, Room 271
Stony Brook, NY 11794-8276
Telephone: 631-444-2111
Fax: 631-444-6035
Office of Financial Aid and Scholarship Services
Stony Brook Union, Suite 208
Stony Brook, NY 11794-3252
Telephone: 631-632-6840
Fax: 631-632-9525
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