2014-2015 Verification Worksheet V-5 - Bethune

2014-2015
Verification Worksheet V-5
Your 2014-2015 Free Application for Federal Student Aid (FAFSA) was selected for a review in a process called verification. The law states
that before awarding Federal Student Aid, we must ask you to confirm the information you and (or) your parents reported on your FAFSA. To
verify that you provided correct information, the Office of Student Financial aid will compare your FAFSA with the information on this worksheet
and with any other required documents. If there are differences, your FAFSA information may need to be corrected.
You must complete and sign this worksheet, attach any required documents and submit the form and other documentation to the Office of Student
Financial Aid at 640 Dr. Mary McLeod Bethune Boulevard, Daytona Beach FL, 32114. The Office of Student Financial Aid may ask for
additional information. If you have any questions about Verification please contact the Office of Student Financial Aid at (386)481-2620 as soon
as possible so that your financial aid will not be delayed.
DO NOT LEAVE BLANK- COMPLETE ALL SECTIONS!
1. STUDENT INFORMATION
Last Name
First Name
Student ID Number
2. FAMILY INFORMATION
Please check appropriate box below:
**IF INDEPENDENT COMPLETE STEPS 1-6 & 9 ONLY**
 If you are a dependent student, include:
If you are an independent student, include:

Yourself, even if you do not live with your parents

Yourself

Your parent(s) (including step-parents)

Your spouse(if you are married)

Your parent(s) other dependent children if
a)your parent(s) will provide more than half of their
support from July 1, 2013 through June 30, 2014, or
b)the children would be required to provide parental
information when applying for Federal Student Aid

Your children if you will provide more than half
of Their support from July 1, 2013 through June
30, 2014

Other people only if they live in your household
and you provide more than half of their support
and will continue to do so from July 1, 2013
through June 30, 2014

Other people only if they now live in your parent(s)
Household and your parent(s) will provide more than
half of their support from July 1,2013 through June
30,2014
Full Name
Age
Relationship
College
Self
Bethune Cookman University
Will be Enrolled at
Least Half Time
3. SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM ((formerly known as Food Stamps)
Yes
No Did someone listed in the household in the chart above received benefits from SNAP anytime during
the 2012 or 2013 calendar years?
If asked by the school, I will provide documentation of receipt of SNAP benefits during 2013 and/or 2013.
“SUSTAINING A LEGACY OF FAITH, SCHOLARSHIP AND SERVICE”
Verification Worksheet (V-1)2014-2015
Bethune-Cookman University
revision: 12/13/2013
Students ID#:_____________
4. 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 2014–2015:
 A copy of the student’s high school diploma.
 A copy of the student’s final official high school transcript that shows the date when the diploma was awarded.
 A copy of the student’s General Educational Development (GED) certificate or GED transcript.
 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.
 If State law requires a homeschooled student to obtain a secondary school completion credential for
homeschool (other than a high school diploma or its recognized equivalent), a copy of that
credential.
 If State law does not require a homeschooled student to obtain a secondary school completion credential for homeschool
(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 documents the successful
completion of a secondary school education in a homeschool setting.
5-A. IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE
(To Be Signed at the Institution with Financial Aid Staff)
(If unable to sign at the Institution continue to step 4b)
The student must appear in person at Bethune-Cookman University to verify his or her identity by presenting a valid governmentissued photo identification (ID), such as, but not limited to, a driver’s license, other state-issued ID, or passport. The institution will
maintain a copy of the student’s photo ID that is annotated with the date it was received and the name of the official at the institution
authorized to collect the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the following:
Statement of Educational Purpose
I certify that I
am the individual signing this
(Print Student’s Name)
Statement of Educational Purpose and that the federal student financial assistance
I may receive will only be used for educational purposes and to pay the cost of attending Bethune-Cookman University for 20142015.
(Student’s Signature)
Advisor Name
Student ID #
Date
Advisor Signature
Date
“SUSTAINING A LEGACY OF FAITH, SCHOLARSHIP AND SERVICE”
Verification Worksheet (V-1)2014-2015
Bethune-Cookman University
revision: 12/13/2013
Students ID#:_____________
5 B. IDENTITY STATEMENT OF EDUCATIONAL PURPOSE
(To Be Signed by a Notary if Student is Not Present at the Institution)
If the student is unable to appear in person at Bethune-Cookman University to verify his or her identity, the student must provide:
(a) A copy of the valid government-issued photo identification (ID) that is acknowledged in the notary
statement below, such as but not limited to a driver’s license, other state-issued ID, or passport; and
(b) The original notarized Statement of Educational Purpose provided below.
Statement of Educational Purpose
I certify that I
am the individual signing this
(Print Student’s Name)
Statement of Educational Purpose and that the federal student financial assistance
I may receive will only be used for educational purposes and to pay the cost of attending Bethune-Cookman University for 20142015.
(Student’s Signature)
(Date)
(Student’s ID Number)
Notary’s Certificate of Acknowledgement
State of
City/County
__
of
On_
_,
before me,
(Date)
personally appeared,
,
(Notary’s name)
_, and provided to me
(Printed name of signer)
on basis of satisfactory evidence of identification
(Type of government-issued photo ID provided) to
be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal
(Notary signature)
My commission expires on
(Date)
(Seal above)
“SUSTAINING A LEGACY OF FAITH, SCHOLARSHIP AND SERVICE”
Verification Worksheet (V-1)2014-2015
Bethune-Cookman University
revision: 12/13/2013
Students ID#:_____________
6. VERIFICATION OF 2013 IRS INCOME TAX RETURN INFORMATION

Check only one box for Student AND only one for Parent
(If it is confirmed that IRS data was not used as indicated the student’s file will be considered incomplete and could delay processing of financial aid)
STUDENT
PARENT (If Dependent)
Student Tax Filers:
Parent Tax Filers:
I used the IRS Data Retrieval Tool (DRT) on my FAFSA.

Important Note: If you used the DRT and later
changed the Information, you must submit a Tax
Return Transcript
I used the IRS Data Retrieval Tool (DRT) on the FAFSA.
 Important Note: if you used the DRT. and later
changed the Information, you must submit a Tax
Return Transcript
I corrected my FAFSA and used the DRT. You must
attach the FAFSA Confirmation page

Iam attaching my 2013 IRS Tax Return Transcript.
B-CU will not accept copies of 1040’s or Account
Transcripts.
I corrected the FAFSA and used the DRT. You must
Attach the FAFSA confirmation page
I filed an amended 2013 Tax Return or have filed for an
extension. Contact the Office of Student Financial Aid
for additional steps.
I filed an amended 2013 Tax Return or have filed for an
extension. Contact the Office of Student Financial Aid for
additional steps.
Student Non Tax Filers:
I am attaching my 2013 IRS Tax Return Transcript.
B-CU will not accept copies of 1040’s or Account
Transcripts
Parent Non Tax Filer:
I did not file a 2013 Tax Return AND I am not required to
File a Tax Return. If you are an Independent student and
select this option, further clarification may be required if
questions 4-11 do not sufficiently show how you supported
yourself and your dependents in 2013
I did not file a 2013 Tax Return AND I am not required to
File a Tax Return. If you are an Independent student and
select this option, further clarification may be required if
questions 4-11 do not sufficiently show how you supported
yourself and your dependents in 2013
I did not file a 2013 Tax Return AND I am not required
in 2013. If you are an Independent Student and select this
options, list all your employer(s) and income earned below
AND attach IRS W-2 form(s)
I did not file a 2013 Tax Return AND I am not required
in 2013. If you are an Independent Student and select this
options, list all your employer(s) and income earned below
AND attach IRS W-2 form(s)
Employer
Earnings/Income
Employer
Earnings/Income
For Faster alternative to request the IRS Tax return Transcript, you can correct your FAFSA online by going to www.fafsa.ed.gov and use the
IRS Data Retrieval Tool (DRT). If you use the DRT, and change the information, you must submit a Tax Return Transcript.
There are 3 ways to obtain your IRS Tax Return Transcript*
1. Call 1-800-908-9946. Make sure to request a Tax Return Transcript not an account transcript
2. Go to www.IRS.gov and click on the “Order a Return or Account Transcript” link
3. Go to your local IRS office (Daytona Beach area location: 149 S. Ridgewood Ave.)
Be aware that option 1 & 2 can take up to 10 business days for the transcript to arrive which may delay the student’s ability to complete their file by the deadline.
*You will need the Social Security Number, date of birth, and the address on file with the IRS (normally this will be the address used when the 2013 IRS tax return
was filed). It takes up to two weeks for IRS income information to be available for electronic IRS tax return filers, and up to eight weeks for paper IRS tax return filers.
7. CERTIFICATION: By signing this worksheet, I certify all the information reported is complete and correct:
Student Signature
Date
Student Name (Please Print)
Parent Signature (IF student is dependent)/Spouse Signature(IF Student is married)
Date
Student ID Number
Parent/Spouse Name(Please Print)
“SUSTAINING A LEGACY OF FAITH, SCHOLARSHIP AND SERVICE”
Verification Worksheet (V-1)2014-2015
Bethune-Cookman University
revision: 12/13/2013
Students ID#:_____________
EXPLINATION OF UNSUAL CIRCUMSTANCES
Tax Filing Extension
Verification of 2013 IRS Income Tax Return Information for Individuals Granted a
Filing Extension by the IRS
If an individual is required to file a 2013 IRS income tax return and has been granted a filing extension by the IRS,
provide the following documents:


A copy of the IRS Form 4868, ‘‘Application for Automatic Extension of Time to File U.S. Individual
Income Tax Return,’’ that was filed with the IRS for tax year 2013; and
A copy of IRS Form W–2 for each source of employment income received for tax year 2013 and, if selfemployed, a signed
statement certifying the amount of the individual’s AGI and the U.S. income tax paid
for tax year 2013.
Amended Tax Return
Verification of 2013 IRS Income Tax Return Information for Individuals Who Filed an Amended IRS Income
Tax Return
If an individual filed an amended IRS income tax return for tax year 2013, provide both of the following:


A signed copy of the original 2013 IRS income tax return that was filed with the IRS or a 2013 IRS Tax Return
Transcript (signature not required) for the 2013 tax year; and
A signed copy of the 2013 IRS Form 1040X, “Amended U.S. Individual Income Tax Return,” that was filed
with the IRS.
Identity Theft
Verification of 2013 IRS Income Tax Return Information for Individuals Who Were Victims of IRS Identity
Theft
A victim of IRS identity theft who has been unable to obtain a 2013 IRS Tax Return Transcript or use the IRS DRT
must provide a signed copy of the 2013 paper IRS income tax return that was filed with the IRS and a signed copy of
IRS Form 14039 “Identity Theft Affidavit” if one was submitted to the IRS. If the individual did not keep a copy of
Form 14039 or the IRS did not require him or her to submit one, he or she may provide one of the following:


A statement signed and dated by the individual indicating that he or she was a victim of IRS identity theft and that
the IRS is investigating the matter. The statement must also indicate that the individual submitted a Form 14039 to
the IRS, but did not keep a copy of it or that he or she was not required to file the form. This document must have
an IRS stamp to be valid.
A copy of a police report if it was filed related to the IRS identify theft.
Non-US Tax Return
Verification of 2013 Income Tax Return Information for Individuals Who Filed Non-IRS Income Tax Returns
If an individual filed or will file a 2013 income tax return with Puerto Rico, another U.S. territory (e.g., Guam,
American Samoa, the U.S. Virgin Islands, the Northern Marianas Islands), or with a foreign country, provide a signed
copy of that 2013 income tax return(s)
“SUSTAINING A LEGACY OF FAITH, SCHOLARSHIP AND SERVICE”
Verification Worksheet (V-1)2014-2015
Bethune-Cookman University
revision: 12/13/2013
Students ID#:_____________