ALLEGHENY COLLEGE FINANCIAL AID OFFICE - Amazon Web ...
USE ONLY 2015 INCOME INFORMATION FOR VERICATION OF YOUR 2017-2018 FAFSA Independent Student Verification Statement Allegheny College 2017-2018 Student______________________________________________Allegheny Student I.D. Number___________________ Address__________________________________________________________________________________________ Street/P.O. Box City State Zip Code Cell Phone Number (_____)____________________Home Phone Number (_____)____________________ Email Address__________________________________________________
1. YOUR HOUSEHOLD SIZE AND NUMBER IN COLLEGE List the name, age, and relationship of each person who is a member of your household. Include yourself, your spouse (if married) and your dependent children (if applicable) if you will provide at least half of their support during the 2017-2018 academic year (July 1, 2017 through June 30, 2018). For any household members who will be attending college during 2017-2018, please indicate where they will enroll. Name
Age
Relationship
Self
If Attending College, List Name of College
Allegheny College
2. 2015 Student and Spouse (if married) Income Verification
Will be Enrolled at least Half Time (Yes or No) Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
(Must Check One)
Check here if you, and your spouse (if married), have used the IRS DRT in FAFSA on the Web to transfer 2015 income tax return information into the student’s FAFSA.
Check here if you, and your spouse (if married), have not yet used the IRS DRT in FAFSA on the Web, but will use the tool to transfer 2015 income tax return information into the student’s FAFSA. IRS Data Retrieval Tool instructions can be found at www.allegheny.edu/apply-finaid
Check here if you, and your spouse (if married) are unable to use the IRS DRT in FAFSA on the Web and instead will provide Allegheny College with a 2015 IRS Tax Return Transcript. This process will take 1-2 weeks longer than using the IRS Data Retrieval Tool. To request a tax transcript, please visit the website www.irs.gov. Instructions are also available at www.allegheny.edu/apply-finaid.
Check here if you, are your spouse (if married), are not required to file a 2015 U.S. Federal Tax Return. Please complete and return a ‘Student Statement of Non-Filing’ form, 4506-T IRS non-filing verification form, (available at www.allegheny.edu/studentnonfiling) and copies of all 2015 W-2s with this Verification Statement. • Visit www.irs.gov/publications/p501/ar02.html#en_US_2013_publink1000220720 to view tax filing requirements and thresholds.
3.
2015 Untaxed Income – Enter amounts received in 2015 for you, your spouse (if married), and all dependent children in spaces provided below. Do Not Leave Blank Spaces - Enter ‘n/a’ or ‘zero’ if any items below are not applicable
a) Housing, food, or living allowances (clergy/military) $_______ (Do not include the value of on-base military housing or the value of a basic military allowance for housing) b) Child support received
$_______
c) Veterans non-education benefits
$_______
e) Untaxed Workman’s Compensation
$_______
f) Untaxed Disability (not Social Security Disability)
$_______
g) Payment(s) to Tax Deferred Retirement/Pension Plan(s)
$_______
Example W-2
Total amounts from all parent W-2 wage statements in boxes 12a-12d with codes D, E, F, G, H, or S. (Amounts will be shown in the highlighted box on the right – Do NOT include ‘DD’ code) h) Untaxed Health Savings Account (line 25 on IRS Form 1040)
$_________
2015
i) Money received or paid on behalf of the student $_________ [excluding money from spouse (if married) – e.g.: cash, 529 plans, gift cards, etc.] j)
Other:___________________________________________
$_________
(Do Not include as Untaxed Income – extended foster care benefits, student aid, Earned Income Credit, Additional Child Tax Credit, Untaxed Social Security Benefits, SSI, combat pay, Workforce Innovation & Opportunity Act (WIOA) educational benefits, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels.
5. Sign this Worksheet By signing this worksheet, we certify that all the information reported on it is complete and correct.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
_________________________________________________________________ __________________________________ Student Signature Required Date
_________________________________________________________________ __________________________________ Spouse Signature Required (if married) Date
Fax: (814) 332-2349 Email: [email protected] Allegheny College Financial Aid Office 520 North Main St. Meadville, PA 16335
1. YOUR HOUSEHOLD SIZE AND NUMBER IN COLLEGE List the name, age, and relationship of each person who is a member of your household. Include yourself, your spouse (if married) and your dependent children (if applicable) if you will provide at least half of their support during the 2017-2018 academic year (July 1, 2017 through June 30, 2018). For any household members who will be attending college during 2017-2018, please indicate where they will enroll. Name
Age
Relationship
Self
If Attending College, List Name of College
Allegheny College
2. 2015 Student and Spouse (if married) Income Verification
Will be Enrolled at least Half Time (Yes or No) Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
(Must Check One)
Check here if you, and your spouse (if married), have used the IRS DRT in FAFSA on the Web to transfer 2015 income tax return information into the student’s FAFSA.
Check here if you, and your spouse (if married), have not yet used the IRS DRT in FAFSA on the Web, but will use the tool to transfer 2015 income tax return information into the student’s FAFSA. IRS Data Retrieval Tool instructions can be found at www.allegheny.edu/apply-finaid
Check here if you, and your spouse (if married) are unable to use the IRS DRT in FAFSA on the Web and instead will provide Allegheny College with a 2015 IRS Tax Return Transcript. This process will take 1-2 weeks longer than using the IRS Data Retrieval Tool. To request a tax transcript, please visit the website www.irs.gov. Instructions are also available at www.allegheny.edu/apply-finaid.
Check here if you, are your spouse (if married), are not required to file a 2015 U.S. Federal Tax Return. Please complete and return a ‘Student Statement of Non-Filing’ form, 4506-T IRS non-filing verification form, (available at www.allegheny.edu/studentnonfiling) and copies of all 2015 W-2s with this Verification Statement. • Visit www.irs.gov/publications/p501/ar02.html#en_US_2013_publink1000220720 to view tax filing requirements and thresholds.
3.
2015 Untaxed Income – Enter amounts received in 2015 for you, your spouse (if married), and all dependent children in spaces provided below. Do Not Leave Blank Spaces - Enter ‘n/a’ or ‘zero’ if any items below are not applicable
a) Housing, food, or living allowances (clergy/military) $_______ (Do not include the value of on-base military housing or the value of a basic military allowance for housing) b) Child support received
$_______
c) Veterans non-education benefits
$_______
e) Untaxed Workman’s Compensation
$_______
f) Untaxed Disability (not Social Security Disability)
$_______
g) Payment(s) to Tax Deferred Retirement/Pension Plan(s)
$_______
Example W-2
Total amounts from all parent W-2 wage statements in boxes 12a-12d with codes D, E, F, G, H, or S. (Amounts will be shown in the highlighted box on the right – Do NOT include ‘DD’ code) h) Untaxed Health Savings Account (line 25 on IRS Form 1040)
$_________
2015
i) Money received or paid on behalf of the student $_________ [excluding money from spouse (if married) – e.g.: cash, 529 plans, gift cards, etc.] j)
Other:___________________________________________
$_________
(Do Not include as Untaxed Income – extended foster care benefits, student aid, Earned Income Credit, Additional Child Tax Credit, Untaxed Social Security Benefits, SSI, combat pay, Workforce Innovation & Opportunity Act (WIOA) educational benefits, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels.
5. Sign this Worksheet By signing this worksheet, we certify that all the information reported on it is complete and correct.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
_________________________________________________________________ __________________________________ Student Signature Required Date
_________________________________________________________________ __________________________________ Spouse Signature Required (if married) Date
Fax: (814) 332-2349 Email: [email protected] Allegheny College Financial Aid Office 520 North Main St. Meadville, PA 16335
