Independent Web

2018–19 FAFSA Verification Worksheet

Please submit the completed worksheet and any additional documents to Financial Aid at the address below, email it or fax it to 570.585.9470 within 45 days of receipt.

Student Information (Please print)

Name / Last 4 digits of SS#
Street Address
City/State/Zip
Date of birth
Student Phone / Student Email
Driver’s License State / Driver’s License #
Are you a U S Citizen: Yes No

Family Information

List ALL the people in your household, including their names and ages. Also write in the name of the college for any household member who will be enrolled, at least half-time (typically 6 or more credits per semester) in adegree, diploma, or certificate program at an eligible post-secondary educational institution any time between July 1, 2018 and June 30, 2019. If more space is needed, attach a separate sheet of paper with the CSU student's name and last 4 digits of Social SecurityNumber at the top.

Please include:

Yourself

Your spouse (if you are married).

Your and/or your spouse’s children if:

  • You or your spouse will provide more than half of their support from July 1, 2018 through June 30, 2019

(even if they are not living in the home)

Other people if they now live with you and you or your spouse provide more than half of their support andwill continue to provide more than half of their support through June 30, 2019.

Full name / Age / Relationship / Name of College / Will be Enrolled at Least Half Time (Yes or No)

Note: We may require additional documentation if we have reason to believe that the information regarding the household members enrolled in eligible postsecondary educational institutions is inaccurate.

Name / Last 4 digits of SS#

Tax and Income Information

Student / Spouse / Check one of the boxes below, then… / Submit the following required document(s).
I filed or will file a 2016 Federal Income Tax Return and used/will use the IRS Data Retrieval Tool (DRT). / The best way to verify income is by using the IRS DRT that is part of FAFSA. In most cases, no further documentation is needed to verify 2016 income information. Do not submit this worksheet until this has been completed.
I filed a 2016 Federal Income Tax Return and did not/will not use the IRS Data Retrieval Tool (DRT). / Attach a 2016IRS Tax Return Transcript. These can be requested by going to: under the Tools heading on the IRS homepage, click "Get a Tax Transcript." Make sure to request the “IRS Tax Return Transcript” and NOT the “IRS Tax Account Transcript.”
Telephone Request - 1-800-908-9946
I did not work and will not file a 2016 Federal Income Tax Return. / Please contact Financial Aid.

If the student and spouse filed separate 2016 IRS income tax returns, the IRS DRT cannot be used and the 2016 IRS Tax Return Transcript(s) must be provided for each.

____ Check here if a 2016 IRS Tax Return Transcript(s)is provided.

____ Check here if a 2016 IRS Tax Return Transcript(s) will be provided later

Please contact Financial Aid if: the student or spouse had a change in marital status after theend of the 2016 tax year on December 31, 2016; had a rollover from one retirement fund to another in the 2016 tax year; filed anamended tax return; filed an extension; is a victim of identity theft, or; filed a non-IRS income tax return.

**If you and/or your spouse worked in 2016 but are not required to file a 2016 Federal Income Tax Return, please completethe following chart and attach relevant W-2 Form(s) and/or other earning statement(s).List every employer even if the employer did not issue an IRS W-2 form. Attach additional sheet if needed.

Student / Spouse / Employer’s Name / 2016Amount Earned / IRS W-2 Attached?
Bud’s Auto Body Shop (Example) / $2,000 (Example) / yes no
yes no
yes no
yes no

Neither spouse was employed, and neither had income earned from work in 2016

Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2017 that indicates a 2016 IRS income tax return was not filed with the IRS or other relevant tax authority.

____ Check here if confirmation of nonfilingis provided.

____ Check here if confirmation of nonfiling will be provided later

Other Information

Did your and/or your spouse receive a military/clergy housing allowance in the 2016 tax year?
Total Amount Used portionUnused portion
Name / Last 4 digits of SS#

High School Completion Status

Provide one of the following documents that indicate the student’s high school completion status when the student will begin college in 2018–2019. If you have already provided one of these documents to admissions, check the boxthat applies.

A copy of the student’s high school diploma.

For students who completed secondary education in a foreign country, a copy of the “secondary school leaving certificate” or other similar document.

A copy of the student’s final official high school transcript that shows the date when the diploma was awarded.

A state certificate or transcript received by a student after the student passed a State-authorized examination that the State recognizes as the equivalent of a high school diploma (GED test, HiSET, TASC, or other State-authorized examination).

An academic transcript that indicates the student successfully completed at least a two-year program that is acceptable for full credit toward a bachelor’s degree.

For a student who was homeschooled in a state where state law requires the student to obtain a secondary school completion credential for homeschooling (other than a high school diploma or its recognized equivalent), a copy of that credential.

For a student who was homeschooled in a state where state law does not require the student to obtain a secondary school completion credential for homeschooling (other than a high school diploma or its recognized equivalent), a transcript, or the equivalent, signed by the student's parent or guardian, that lists the secondary school courses the student completed and includes a statement that the student successfully completed a secondary school education in a homeschool setting.

If the student is unable to obtain the documentation listed above, he or she must contact Financial Aid.

Identity and Statement of Educational Purpose(To Be Signed at the Institution)

If this is required, we will contact you and forward the necessary documentation to you.

Statement of Certification

Each person signing this form certifies that all the information reported is complete and accurate to the best of their knowledge.

WARNING: If you purposely give false or misleading information on this worksheet you may be fined, sentenced to jail, or both.

Student Signature______/ Date______
Spouse Signature (if the student is married)______/ Date______