xFAVER REV 2/05/2020
LAKES REGION COM MUNITY COLLEGE
2020- 202 1 VERIFICATION WORKSHEET
Your 2020-2021 Free Application for Federal Student Aid (FAFSA) was selected for a review process called verification. In the
verification process we will compare your FAFSA with information on this worksheet and any other required documents. We
may ask for additional information later. If you filed as a Dependent student on the FAFSA, you and your parent(s) will need to
complete this form. If you filed as an Independent student on the FAFSA, you and your spouse (if applicable), will need to
complete this form.
We are unable to award financial aid until the verification process has been completed. It is imperative that you submit any
requested documents (signed and completed) immediately upon request. If you have questions about the verification process,
please contact the financial aid office so that your financial aid will not be delayed.
Section A: Student Information
_______________________________________________________________ ____________________
Last Name First M. Student Social Security Number
(Will never be displayed or revealed)
_______________________________________________ ____________________
Address (include Apartment Number) Date of Birth
______________________________________________________________ ____________________________
City State Zip Phone Number (include area code)
Are you a RETURNING STUDENT to this college? □ YES □ NO Student E-Mail address: ________________________________________
Section B: Household and College Information
Dependent students, list the individuals who will live in your parent(s)household who meet the criteria below between July 1, 2020 and
June 30, 2021.
Include:
Yourself, even if you don’t live with your parents,
• Your parents/ (including stepparent),
Your parents’ other children, even if they don’t live with your parent(s), if children if (a) your parents will provide more than half of their
support between July 1, 2020 and June 30, 2021, or (b) the children would be required to provide parental information when applying for
Federal Student Aid, and
Other people if they now live with your parents, your parents provide more than half of their support and will continue to provide more than
half of their support between July 1, 2020 and June 30, 2021.
If any household members (other than your parents) will be attending college at least half time between July 1, 2020 and June 30, 2021 and
will be enrolled in a degree or certificate program, include the college next to their name below.
If you need more space, please attach a separate page.
Independent students, list the individuals who will live in your household between July 1, 2020 and June 30, 2021
Include:
Yourself and your spouse if married, and
Your children, if you will provide more than half of their support between July 1, 2020 and June 30, 2021, even if they do not live with you,
and
Other people if they now live with you and you provide more than half of their support and you will continue to provide more than half of
their support between July 1, 2020 and June 30, 2021.
•If any household members will be attending college at least half time between July 1, 2020 and June 30, 2021 and will be enrolled in a degree
or certificate program, include the college next to their name below.
•If you need more space, please attach a separate page.
Full Name
Age
Relationship
College
SELF
CCSNH
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xFAVER REV 2/05/2020
Section C: IF YOU FILED A TAX RETURN for 2018: Data Retrieval Information
1. Student/Spouse Income Information Check the box that applies:
I/We used/will use the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer 2018 IRS income information
into my FAFSA and have not made any changes to the information transferred.
OR
I/we am/are supplying the school with a 2018 IRS Tax Transcript. (IRS Tax Transcripts can be requested directly from the IRS
website: www.IRS.GOV/Individuals/Get-Transcript
)
2. Parent(s) Income Information (dependent students only) Check the box that applies:
My parent(s) used/will use the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer 2018 IRS income
information into my FAFSA and have not made any changes to the information transferred.
OR
My parent(s) is/are supplying the school with a 2018 IRS Tax Transcript. (IRS Tax Transcripts can be requested directly from the
IRS website: www.IRS.GOV/Individuals/Get-Transcript
)
Important Note:
If the student/spouse and/or parent(s) filed, or will file, an amended 2018 IRS tax return, you must supply the school with a signed copy of
the 1040X in addition to your IRS Tax Transcript.
Only complete Section D and/or E if you and/or your parent(s)
DID NOT file a tax return for 2018
Section D: STUDENT/SPOUSE Income Information
Please check only one box
A. Check here if you, and/or your spouse, (if applicable) were not employed and had no income earned from work in 2018.
B. Check here if you, and/or your spouse, (if applicable) will not file and are not required to file a 2018 Federal tax return BUT DID
have earned income from work.
If you checked Box B above, list the employer(s) and report all income from work in 2018 in the area below and attach copies of all W-2
forms issued to the student/spouse by employers:
Employee’s Name
Employer’s Name
W-2 Form Issued? Y/N
If you need more space, please attach a separate page.
Section E: PARENT(S) Income Information (DEPENDENT STUDENTS ONLY)
Please check only one box
A. Check here if your parent(s) were not employed and had no income earned from work in 2018.
B. Check here if your parent(s) will not file and were not required to file a 2018 Federal tax return BUT DID have earned income from
work.
If you checked Box B above, list the employer(s) and report all income from work in 2018 in the area below and attach copies of all W-2
forms issued to the parent(s) by employers:
Employee’s Name
Employer’s Name
W-2 Form Issued? Y/N
If you need more space, please attach a separate page.
Section F: Signatures -- Both the student and at least one parent (dependent students only) must sign.
By signing I/we certify that all of the information I/we provided is true and complete to the best of my/our knowledge and I/we agree,
if asked, to provide information that will verify the accuracy of this completed form.
____________________________________________________________ ___________________________
Student Signature Date
____________________________________________________________ ___________________________
Parent Signature Date
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