Request for Student’s Social Security Number
(Taxpayer Identication Number Form W-9S)
Submit this form to the College.
Do NOT send to the IRS.
Read, complete, sign, and submit this form to CBC Student Records, either in person or by mail at:
Student Records
Columbia Basin College
2600 North 20th Avenue MS-H4
Pasco, WA 99301-3379
Part I
Name of Student Social Security Number
(Taxpayer Identication Number)
Address (number, street, and apt. or suite no.) CBC Student ID Number
City, state, and ZIP code
Part II
Under penalties of perjury I certify that the Social Security Number shown on this form is my true Social Security
Number.
Student Signature ____________________________________________________ Date ____________________
OR
Part III
I do not wish to provide my Social Security Number. I have read this document and the attached letter, and am
aware of the following: Pursuant to the Internal Revenue Service (IRS) Internal Revenue Code (IRC) 6050S and 6051
the College is required to solicit from students. The IRS can levy penalties on the student for refusing to provide his/
her SSN and subsequently claiming qualifying expenditures for the Hope Scholarship Tax Credit and/or the Lifetime
Learning Tax Credit.
Student Signature ____________________________________________________ Date ____________________
SUBSTITUTE W-9S FORM
SEE NEXT PAGE FOR INSTRUCTIONS
Request for Student's Taxpayer Identication Number
Submit this form to the College.
Do NOT send to the IRS.
Instructions
Purpose
Pursuant to the Internal Revenue Service (IRS) Internal Revenue Code (IRC) 6050S and 6051 the College is required
to solicit and students are required to provide Social Security Numbers. Failure to comply with this requirement
may result in civil penalties, assessed by the IRS. The purpose of providing Social Security Numbers is for the issu-
ance of Form 1098-T, Tuition Payments Statement. The College reports the amount you paid for qualifying tuition
and fees to both you and the IRS on Form 1098-T. The 1098-T contains information related to claiming a tuition and
fee deduction, the Hope Scholarship credit and/or the Lifetime Learning Credit on your taxes. The College also uses
Social Security Numbers to verify enrollment, degree(s) and transcripts, administer nancial aid, collect student
debt, and conduct research. The College will only utilize your Social Security Number in a manner that does not
permit personal identication of you. The Social Security Number is condential and, pursuant to state law (RCW
28B.10.042) and the Federal Family Educational Rights and Privacy Act (FERPA), will not be released and only used
as stated above.
Part I
You must complete this part.
Name and address. Enter the name and mailing address of the student.
Social Security Number (Taxpayer identication number). Enter your Social Security number (SSN). If you have
an IRS Individual Taxpayer Identication Number (ITIN) because you are not eligible to obtain an SSN, enter the ITIN.
If you DO NOT have an SSN or ITIN and you have applied for one or you intend to apply for one soon, write Applied
For in the space provided.
How to get an SSN or ITIN. To apply for an SSN, use Form SS-5, Application for a Social Security Card, that you can
get from your local Social Security Administration oce. To apply for an ITIN because you are not eligible to get an
SSN, use Form W-7, Application for IRS Individual Taxpayer Identication Number, that you can get from the IRS by
calling 1-800-TAX-FORM (1-800-829-3676) or from the IRS website at www.irs.gov.
Part II
Please sign and date indicating the student is providing a SSN or ITIN.
Part III
Please read, sign, and date this section ONLY if you are not willing to provide your Social Security Number. By sign-
ing you acknowledge that you are aware of the following: Pursuant to the Internal Revenue Service (IRS) Internal
Revenue Code (IRC) 6050S and 6051 the College is required to solicit Social Security Numbers from students. The
IRS can levy penalties on the student for refusing to provide his/her SSN and subsequently claiming qualifying ex-
penditures for the Hope Scholarship Tax Credit and/or the Lifetime Learning Tax Credit.
Penalties
Failure to furnish correct SSN or ITIN. If you fail to furnish your correct SSN or ITIN to the requester, you are subject
to a penalty unless your failure is due to reasonable cause and not to willful neglect.
Misuse of SSN or ITINs. If the requester discloses or uses your SSN or ITIN in violation of Federal law, the requester
may be subject to civil and criminal penalties.
Privacy
Section 6109 of the Internal Revenue Code requires you to provide your correct SSN or ITIN to persons who must le
Act
information returns with the IRS to report certain information. The IRS uses the numbers for identication purposes
and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of
Notice
Justice for civil and criminal litigation and to cities, states, and the District of Columbia to carry out their tax laws.
The IRS may also disclose this information to Federal and state agencies to enforce Federal nontax criminal laws and
to combat terrorism.
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