Your application was selected for review in a process called “Verification.” In this process, your school will be comparing information from your application with copies of you and your parent(s)’ or spouse’s (if you are married) 2014 IRS Tax Return Transcripts, and W-2 forms or other financial documents. The law says 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, you or your school may need to make corrections electronically or by using your Student Aid Report (SAR).

Complete this verification form and submit it to your financial aid administrator as soon as possible, so that your financial aid won’t be delayed.

A. Student Information

______

Last Name First Name M.I. Cowley Student ID Number

______

Address (includes apt. no.) Student’s Social Security Number

______

City State Zip Code Date of Birth

______

Phone Number (include area code)

B. Family Information

If Dependent:

List the people living in your parent(s)’ household, including yourself, your parents(even if you don’t live with your parents), and other children that your parents provide more than half their support and will continue to provide half their support from July 1, 2015 through June 30, 2016 (even if they do not live with your parents). Also include other people living in your parent’s household that they provide more than half their support to.

If Independent:

List the people in your household including yourself, your spouse (if you have one), and your children, if you provide more than half their support even if they do not live with you. Also include other people if they live with you, and you provide more than half of their support.

Write the names of all household members in the space below. Also write the name of the college for any household member, excluding your parent(s), who will be attending at least half time between July 1, 2015 and June 30, 2016, and will be enrolled in a degree, diploma, or certificate program. If you need more space, attach a separate page.

C. Student’s Tax & Income Information

1. Check only one below:

A. ____Check here if you are attaching a 2014 IRS Tax Return Transcript or have requested it from the IRS______(date requested)

B. ____Check here if you did not earn income from work and will not file and are not required tofile a 2014 U.S. Income Tax Return. You will also need to submit a Statement of Income form.

C. ____ Check here if you earned wages but did not file a tax return. You will need to submit a copy of the W2s or a Wage and Income Transcript from the IRS.

2. Did you receive or pay any child support in 2014? Yes____No ____

If yes, please indicate:

Amount paid for year: $______

Name of person who paid child support: ______

Name of child support recipient: ______

Name of child(ren) for whom child support was paid:

______

3. Funds received from other untaxed income. (See Question 44 of the Free Application for Federal Student Aid.)

Sources of Untaxed Income / 2014 Amount / Sources of Untaxed Income / 2014 Amount
a. Workman’s Comp / $ / d. SNAP Benefits / $
b. Untaxed Pensions / $ / e. Social Security Benefits / $

D. Parent(s)’ (if student is dependent) or Spouse’s (if student is married) Tax & Income Information

1. Check only one below:

A. ____Check here if you are attaching a 2014 IRS Tax Return Transcript or have requested it from the IRS______ (date requested)

B. ____Check here if you did not earn income from work and will not file and are not required to file a 2014 U.S. Income Tax Return. You will also need to submit a Statement of Income form.

C. ____ Check here if you earned wages but did not file a tax return. You will need to submit a copy of the W2s or a Wage and Income Transcript from the IRS.

2. Did you receive or pay any child support in 2014? Yes____No ____

If yes, please indicate:

Amount paid for year: $______

Name of person who paid child support: ______

Name of child support recipient: ______

Name of child(ren) for whom child support was paid:

______

3. Funds received from other untaxed income. (See Question 44 of the Free Application for Federal Student Aid.)

Sources of Untaxed Income / 2014 Amount / Sources of Untaxed Income / 2014 Amount
a. Workman’s Comp / $ / d. SNAP Benefits / $
b. Untaxed Pensions / $ / e. Social Security Benefits / $

E. Certification and Signatures

Each person signing this form certifies that all of the

information reported on it is complete and correct.If

Dependent, the student and at least one parent must sign

and date. If Independent, spouse’s signature is optional.

______

Student’s SignatureDate

______

Parent’s or Spouse’s SignatureDate