2014-15 Verification Worksheet

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2014-15 Verification Worksheet
________________
Empower Number
___________________________________________________________
Last Name
First Name
2014-15 Verification Worksheet
Your Free Application for Federal Student Aid (FAFSA) has been selected for a review process called verification. During this
process, the Financial Aid office will compare the information you reported on your FAFSA with additional documents that you are
required to submit to our office. Federal law mandates that we complete this review prior to awarding you any federal financial aid. It
is to your advantage to complete this process as soon as possible so that your financial aid won’t be delayed.
When filing the FAFSA, students, spouses, and parents should transfer federal tax return information electronically from the Internal
Revenue Service (IRS) onto the FAFSA using the IRS Data Retrieval Tool. This tax return information, if unchanged, will be
considered “verified” for FAFSA purposes and you will not be required to submit a 2013 Federal Tax Return Transcript from the IRS.
If you filed a 2013 Federal Tax Return and are unable to transfer your tax return information onto your FAFSA using the IRS Data
Retrieval Tool, you are required to submit a 2013 Federal Tax Return Transcript from the IRS with this Verification Worksheet. You
can request a tax return transcript at www.irs.gov/transcript - select “Get Transcript ONLINE.”
If you are required to but have not yet filed your 2013 Federal Tax Return, you must do so prior to completing the verification process.
Complete this worksheet and return it with all required documentation attached. Include your Empower Number on all pages of each
document. Incomplete and/or unsigned documents will be returned for completion and will delay processing time.
ALL STUDENTS (If you are married also report for your spouse):
Check only one box
Check this box if you have filed your 2013 Federal Tax Return(s)
Check this box if you did not, will not, and are not required to file a 2013 Federal Tax Return
PARENT(S) OF DEPENDENT STUDENTS:
Check only one box.
Check this box if you have filed your 2013 Federal Tax Return(s)
Check this box if you did not, will not, and are not required to file a 2013 Federal Tax Return
ALL STUDENTS:
If you, your spouse, or your parent(s) filed a 2013 Amended Federal Tax Return, you are required to attach each of the following:
A signed copy of the original 2013 Federal Tax Return that was filed with the IRS
A signed copy of the IRS Form 1040X that was filed with the IRS
A 2013 Federal Tax Return Transcript
ALL NON-TAX FILERS:
If you were not required to file a 2013 Federal Tax Return but you did work, list below all employers and income earned from each
employer in 2013. Use W-2 forms or other earnings statements to complete this section and attach copies of those documents.
Student/Spouse/Parent(s) Name
Employer/Source of Income Earned from Work
2013 Amount
$
$
$
$
________________
Empower Number
___________________________________________________________
Last Name
First Name
ALL STUDENTS:
Dependent Students
(You were required to report parent information on the FAFSA)
Independent Students
(You were not required to report parent information on the
FAFSA)
List your family members below, including:
List your family members below, including:
Yourself (even if you do not live with your parents)
Yourself
Your parent(s) (list only the parent(s) whose information
Your spouse (if married)
was provided on the FAFSA
Your children and/or stepchildren (do not include
Your parents’ other children, if your parents provide
children for whom you are paying child support)
more than half of their support and the children would
Other people, only if they live with you now, they
be considered dependent when applying for federal
receive more than half of their support from you (and
student aid (do not include children for whom your
your spouse, if married), and they will continue to
parents are paying child support)
receive this support between July 1, 2014 and June 30,
Other people, only if they live with your parent(s) now,
2015
they receive more than half of their support from your
parents, and they will continue to receive this support
between July 1, 2014 and June 30. 2015
Full Name of Family Member
Age
Relationship to Student
College*
Self
Mercy College
Enrollment
Status**
(FT/HT/LHT)
*If any family member, excluding parents, will be attending college at least half-time between July 1, 2014 and June 30, 2015,
and will be enrolled in a degree, diploma, or certificate program, also include the name of the college they will be attending.
________________
Empower Number
___________________________________________________________
Last Name
First Name
LIST BELOW OTHER TYPES OF INCOME YOU MAY HAVE RECEIVED IN 2013:
Student(and
spouse,if
married)
$
$
$
Source of Untaxed Income Received in 2013
Child Support RECEIVED for all children. Don’t include foster care or adoption
payments
Housing, food, and other living allowances paid to members of the military, clergy,
and others (including cash payments and cash value of benefits). Don’t include the
value of on base military housing of the value of a basic military allowance for
housing
Veterans’ non-education benefits, such as Disability, Death Pension, or Dependency
and Indemnity Compensation (DIC), and/or VA Educational Work-Study
allowances.
Other untaxed income such as workers’ compensation, disability, etc. Also include
the untaxed portions of health savings accounts from IRS Form 1040-line 25.
$
Parent(s)
$
$
$
$
Money received by you to help with bills, living expenses, other educational costs,
etc. This includes money that you received from a non-custodial parent that is not
part of a legal child support agreement.
$
$
$
Payments to tax-deferred pension and retirement savings plans (paid directly or
withheld from earnings), including, but not limited to, amounts reported on W-2
forms in Boxes 12a through 12d, codes D, E, F, H, and S. Don’t include amounts
reported in code DD (employer contributions toward employee health benefits).
$
AS OF THE DATE YOU FILED YOUR 2014-2015 FAFSA, PLEASE INDICATE MARITAL STATUS BELOW:
DEPENDENT STUDENTS:
My parent(s) marital status is:
Report the marital status only for the parent(s) whose information was included on the FAFSA
Never married
Unmarried and both parents are living together
Married or remarried. Provide the month and year your parents were married:
Month:________ Year:_________
Divorced or separated. Provide the month and year your parents were divorced or separated:
Month:_________ Year:_________
Widowed. Provide the month and year your parent was widowed
Month:_________Year:_________
INDEPENDENT STUDENTS:
My Marital status is:
Never married
Married of remarried. Provide the month and year you were married
Month:_______Year:_________
Divorced or separated. Provide the month and year you were divorced or separated.
Month:_______Year:_________
Widowed. Provide the month and year you were widowed.
Month:_______Year:_________
________________
Empower Number
___________________________________________________________
Last Name
First Name
ALL STUDENTS AND PARENTS OF DEPENDENT STUDENTS ARE REQUIRED TO PROVIDE SIGNATURES BELOW:
Certification Statement: By signing this worksheet, I (we) certify that all of the information reported above, used to determine
eligibility for federal student financial aid, is complete and correct. WARNING: If you purposely give false or misleading
information on this worksheet, you may be fined, sentenced to jail, or both.
__________________________________________________________
Student Signature
Date
__________________________________________________________
Parent Signature
Date
RETURN TO:
Mercy College
Financial Aid Office
2221 Madison Ave
Toledo, OH 43604
Fax Number:
419-251-0969
Email:
[email protected]
Questions? Please contact the Financial Aid Office at 419-251-1219

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