A. Student Information

2014-2015Verification Worksheet

Your application was selected for review in a process called “Verification.” In this process, we will be comparing information on your FAFSA with copies of your and your parent(s)’ 2013IRS Tax Return Transcripts OR signed copy of 1040 Federal Tax Return and other financial documents. Complete this verification form and submit it to our office as quickly as possible with supporting documentation such as IRSTax Return Transcript, W-2 or other documents. Please read each question carefully. Do not hesitate to contact our office if you have any questions.

A. STUDENT INFORMATION

Last nameFirst NameM.I.University ID number (UID)

Address (include apt. no)Date of Birth

CityStateZip CodePhone Number (include area code)

B. STUDENT’S TAX FORMS AND INCOME INFORMATION

1. Check only one box below. Include the 2013 IRS Tax Return Transcript OR signed copy of 1040 Federal Tax Return, a tax return from Puerto Rico or a foreign income tax return. If you do not have a copy of your20131040 FederalTax Return, please visit or call 1-800-908-9946 to request a copy.

[ ] Check here if you are attaching a 2013IRS Tax Return Transcript OR signed copy of 1040 Federal Tax Return.

(notrequired if IRS Data Retrieval was used.)

[ ] Check here if you used the IRS Data Retrieval Tool to complete the student income section of your FAFSA.

[ ] Check here if you will not file and are not required to file a 20131040 Federal Tax Return. Complete question 2.

2. If you did not file and are not required to file a 20131040 Federal Tax Return, list below your employer(s) and any income received in 2013 (send copy of your W-2 form or other earnings statements if available).

Sources / 2013 Amount
$
$
$

3. Funds received for child support and other untaxed income. (See question 44 of the FAFSA).

Sources of Untaxed Income / 2013 Amount / Sources of Untaxed Income / 2013 Amount
a. Child Support / $ / d. / $
b. Social Security (non-taxed) / $ / e. / $
c. Welfare (including TANF) / $ / f. / $

C. PARENT’S TAX FORMS AND INCOME INFORMATION

1. Check only one box below. Include the 2013 IRS Tax Return Transcript OR signed copy of 1040 Federal Tax Return, a tax return from Puerto Rico or a foreign income tax return. If your parent(s) don’t have a copy of the 20131040 Federal Tax Return, please ask your parent(s) to visit or call 1-800-908-9946 to request a copy.

[ ] Check here if you are attaching parents’2013 IRS Tax Return Transcript OR signed copy of 1040 Federal Tax Return.(not required if IRS Data Retrieval was used.)

[ ] Check here if your parent(s) used the IRS Data Retrieval Tool to complete the parent income section of your FAFSA.

[ ] Check here if your parent(s) will not file and are not required to file a 20131040 FederalTax Return. Complete question 2.

2. If your parent(s) did not file and are not required to file a 20131040 Federal Tax Return, list below your parent(s)

wages and any income they received in 2013 to support your household (send copy of your parent(s) W-2 form or other earnings statements if available). If parent earned foreign income but no foreign return was filed, please provide documentation of foreign earnings.

Sources / 2013 Amount
$
$
$

3. Funds received for child support and other untaxed income. (See question 92 of the FAFSA).

Sources of Untaxed Income / 2013 Amount / Sources of Untaxed Income / 2013 Amount
a. Child Support / $ / d. / $
b. Social Security (non-taxed) / $ / e. / $
c. Welfare (including TANF) / $ / f. / $

4. Do your parent(s) own a business? Yes  No. If yes, what is the market value of the business $______

D. MEANS TESTED AID

During 2012 or 2013, did you or your parents, or anyone in your parents’ household receive benefits from any of the following federal benefit programs? Mark all that apply and submit supporting documentation:

___Supplemental Security Income (Please attach copy of 2013 end of year benefit statement)

[ ] Check here if you are attaching your parent’s 2013 end of year benefit statement.

___Food Stamps (Please provide a letter from the applicable agency that shows that Food Stamps were received)

[ ] Check here if you are attaching a letter from the applicable agency that shows that Food Stamps were received.

___Free/ reduced price lunch

___TANF

___WIC

E. HOUSING INFORMATION

Where will you live during the 2014-2015 academic year?

___ Off campus with a parent, guardian, or other relative

___ On campus

___Off campus (not with a relative)

F.PARENT(s) HOUSING: Own_____ Rent_____

Monthly Mortgage $______Monthly Rent $______

G. SIGN THIS WORKSHEET

By signing this form, I/we certify all information reported on this form and within the enclosed documentation is complete and correct. I understand that providing false or misleading information may result in a $20,000 fine, a prison sentence, or both, according to the Higher Education Act of 1965, as amended, Section 490(a). Any false or misleading information is subject to cancellation of all financial assistance.

______

StudentDate

______
Parent Date

University ID No.______

rev 01/11/2014